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A mountain to climb

In his first blog post, former Labour MP Dr Howard Stoate gives his unique take on how the Government's health reforms are developing on the ground

Working as an MP in the last government (as the only practising GP during much of this time) has provided me with an insight into the often Byzantine politics of the health service. But nothing quite prepared me for the challenges in the latest stage of GP commissioning.

Engaging all 120 GPs in our borough in a meaningful way, developing clear priorities for the future, creating an environment of openness and transparency and putting the building blocks in place for world class local health services is a tremendous responsibility.

I am starting from a far better position than many of my GP colleagues, but it is still tough. In Bexley, we have a multi award winning cardiology scheme, a successful diabetes project that is seeing patients returned to primary care, keen GP graduates with strong management experience and various other projects and programmes that have put the south-east London borough in the spotlight in recent months.

The vast majority of our GPs voted in an election in December, with 28 out of 29 of our practices taking part (the only one that didn't missed the vote for administrative reasons). We have introduced democratic change and even the health secretary was keen to visit Bexley to talk to GPs about how greater control could pass to the frontline of patient care.

But with any democratic system, there are tensions and challenges. Anyone who has seen the media coverage of criticism of the health plans cannot have missed the widespread concerns about the pace of change in a difficult economic climate.

There are undoubtedly significant challenges ahead. As a group of GPs, we cannot do anything about some aspects of the overall healthcare environment we are in, for example there is little we can do about the level of money that is available. But there is one thing we can change, and that centres on the services we provide and the patients we see every day. We can ensure that we get maximum value for every penny spent and that we provide the best possible services.

In that sense, I feel there are many benefits to the changes set out in the health bill. There are inevitably some challenges, but there are also many opportunities. In order to make the most of these, we need to see a real culture shift – away from an environment where managers took all the decisions to one where all GPs are fully engaged in the process.

In Bexley as elsewhere, we are at the early stages of this process. We recently held a GP engagement event, where we discussed our commissioning priorities and developed a prospectus, setting out our service aims and aspirations.

We have a GP zone, a secure area of the intranet where GPs can share information and discuss the issues affecting them. These are the first few steps in what is certainly a significant change in ways of thinking and working. First steps are never easy, but hopefully – and with dedication and determination – we will get to a point where GPs readily accept the challenge, where all are engaged in the system and where together, we can make real and lasting change for patients.

Dr Howard Stoate is chair of Bexley Clinical Cabinet and was Labour MP for Dartford from 1997 to 2010

Dr Howard Stoate

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