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How I fought top-down NHS change – and won

Dr John Montgomery explains how he and a group of local GPs overturned local NHS proposals and instead became leaders of change

GPs have found themselves bombarded with structural change in recent years, often imposed from above, with very little clinical input.

Community health care partnerships (CHCPs) were set up across Scotland in 2006 but pioneered in Glasgow where my practice sits, along with the Govan shipyards, Ibrox and 100,000 patients including some of the most deprived in the UK.

The idea was to bring GPs and social care together into a seamless continuity of care. In reality the structure consisted of a group of administrators from the primary care organisation and social work managers flung together.

The result was a centralised, unaccountable cabal of central planners which achieved nothing except complete stagnation. Here, based on our experience, is my advice on how to overcome similar problems in your area.

Pick your battles

GPs are ideally placed to see where policies are not working and in fact damaging care. Here it was proposed that the CHCPs (pronounced chips) were to take the health visitors that had been very closely attached to general practices and a new system would be brought in for them to covering geographical areas of the city.

It meant ripping up things as basic as the immunisation strategy which had achieved great results. This was a step too far and along with other GPs I formed an action group to fight the changes.

The result was a meeting of all 27 practices in the area and a resounding vote of no confidence in the CHCP and in favour of keeping the link between practices and district nurses.

Enlist patient support

In these days of GP bashing stories it's easy to forget that our patients still have massive respect for our profession and what we stand for.

When our action group asked patients if they would help us to try to keep the link with health visitors and their practices, the result was the second biggest petition that has ever been presented to the Scottish government, with tens of thousands of signatures.

We launched a mass campaign, which spread across the whole city where similar plans were being mooted, including posters to enlist support and bring the issue to public attention.

Convert GPs into negotiators

GPs are very busy people and it's not always easy to get them to come forward. We held an open meeting and one of the first questions was did we want to engage at all with the body we were fighting against? There was a majority vote to open up discussions.

We held elections for people prepared to stand as negotiators and there were 15 prepared to stand, although it was unpaid and unresourced, out of 85 GPs, which was good going.

The result was we formed the South West General Practitioners' Committee, of which I am chair although we have decided that its important that the post goes to a different GP each year.

Turn top down into bottom up

At the first meeting between the two sides there must have been 20 plus managers and eight of us. Lots of managers and very few clinicians…

But we were able to identify people who, to use the words of Mrs Thatcher about Mr Gorbachev, we thought we could do business with.

The result wasn't exactly glasnost but it did lead, as from September last year, to the start of two-monthly meetings which has meant we have been able to start driving decisions from the bottom up rather than having decisions imposed.

We have started to make changes to care pathways. While at a macro level what had happened had been a disaster, we all wanted at a local level to see closer co-operation between social workers and GPs and it has started to happen, with ideas such as holding case conferences at GP practices, which has helped us be able to identify children at risk of abuse earlier.

We have negotiated new local enhanced services and arranged for GPs to be paid £200 each for attending the combined meetings to allow them to pay for cover. Since September last year its cost £8,000 in locum payments, which is negligible when you consider clinical directors are being paid £57,000 a year for not doing very much.

Developing models of the future

We have been doing this all in our own time and in the longer term you need administrative support and a more organised structure.

Soon we will vote on whether to form a formal GP federation.

Our GP committee could easily be a forerunner for what could happen elsewhere in Glasgow and further afield. Whether we form a federation or not we have made sure that he voice of local GPs has been heard and made sure we have informed the future direction of healthcare.

The one thing we're not is a talking shop. The experience has taught as that patients are still our allies and, as Nicola Sturgeon, the Scottish health secretary remarked at the time of our petition, it taught the Government ‘not to mess with Glasgow's GPs'.

Dr John Montgomery is a GP in Glasgow and chair of the city's new South West General Practitioners' Committee (GPC)

Dr John Montgomery Dr John Montgomery