Editor Jaimie Kaffash reflects on a bad year but suggests 2023 offers a chance to rescue the profession
This is my last blog of what has been, let’s face it, a terrible year. Things are worse than ever: workforce figures, access, burnout, the patient-doctor relationship, referrals to secondary care and everything else you already know about.
Of course, that could have been written about pretty much any year in the recent past. The difference this year is we had an opportunity to change things. After the catastrophe of Covid in 2020, and the huge vaccination effort of 2021, there was some (misplaced) hope that coming out of the pandemic would involve a reset. We could look at how practices changed the service literally overnight, how parts of GP workload that had seemed sacrosanct were ditched, even how new hospitals were opened within a week (although admittedly that wasn’t exactly a success). Amid the wreckage wrought by the pandemic, we could see what worked and what didn’t work.
Yet we seem to have simply slid back to the old and incredibly flawed way of doing things as quickly as possible. Cowed by the populist sentiments of Telegraph and Mail columnists, NHS England has made no attempt to review the best mix between remote and face-to-face appointments. The QOF was reinstated as soon as it could be. From the Covid-era messaging of ‘only using the NHS when necessary’ (and, by extension, general practice) we have moved to the attitude that patients deserve a convenient appointment of their choosing, regardless of resource or capacity.
We have missed an opportunity. And – although this may not be a very Christmassy sentiment – the ghost of general practice’s (immediate) future is not encouraging. We have a health secretary in England who seems to think the NHS has all the funding it needs, and we are all set for austerity 2.0. The Government has given up on its target to increase GP numbers, other than the GMC’s bold gamble on moving staff and associate specialists into general practice. In other words, we can expect more of the same in 2023.
However, to offer a little festive cheer, I am hoping there might be another opportunity very soon. It could be that 2024 will bring a (very dim) light at the end of the tunnel. It will be time for a new GP contract in England, and just about everyone agrees the current one is unfit for purpose.
The head of primary care for NHS England Dr Amanda Doyle has said she wants it to move away from target-based measures. And LMCs are coming out with genuinely radical solutions. Among those already proposed are a move to a dentist-style system, doing away with home visits and an end to practice lists, with patients allowed to go where they like. Even the BMA has suggested payment based on activity rather than patient list size. Not all of these will be taken forward. But at least they are thinking different.
The basis for the current contract was negotiated a generation ago, and it transformed general practice. The measures introduced – chief among them the dropping of out-of-hours responsibilities – led to a boom in GP numbers and a service that, while it may not have been perfect, looks almost utopian from our current standpoint.
This next contract desperately needs a similar level of big-picture thinking. We should not have high hopes for general practice in 2023, but it may turn out to be one of the most important years in the profession’s history, laying the ground for the following year. Let’s not waste another opportunity.
I hope that, despite all this, you have a merry Christmas and a happy New Year!
This column originally appeared in the December 2022 issue of Pulse
READERS' COMMENTS [3]
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LMCs resemble spoilt kids scrawling long unrealistic fantastical Christmas wish lists to Santa.
Meanwhile their NHSE parents wonder why they can’t be satisfied with an orange in a stocking.
As for the rest of us GP rug rats, we realised long ago that Santa won’t be coming down the chimney bearing gifts, so we need to build our own toys with Uhu glue and sticky back plastic.
As they say in Terminator, “There is no fate but what we make for ourselves”.
Anyone expecting salvation in the 2024 Contract will be severely disappointed.
The Zombie NHS has been clinically dead for years, yet it staggers on regardless because nobody has the political courage to blow its brains out and start afresh.
Nowadays we’re numb to 15 hour ambulance delays, war zone A&Es even in Summer, overwhelming demand, rejected referrals and all the other myriad disasters that used to make our blood boil but we now shrug off as the new normal.
In times of Austerity 2.0 the New Contract will be usual unrealistic silk purse from sow’s ear fantasy, which we will all froth at the mouth about how dreadful it is before adding this new yoke to our already heavy load and dragging ourselves ever onwards, dreaming of a retirement which seems to forever over the horizon.
https://www.gmc-uk.org/news/news-archive/a-message-to-the-profession-by-gmc-chair-professor-dame-carrie-macewen
Today’s GMC email completely misses the mark. At crisis point it psycho-manipulates you into an age old game. “How we treat ourselves and each other”. The spotlight remains on you, not them. It pushes you to be more, to heal yourself and be kind to yourself when others are not – to be that godly human that this country no longer seeks to care for in 2022. Supporting one another, when there is little honest support for you. That lie of speaking out when things go wrong. Huddling like chicks, propping each other up, to the mental slaughter and mind games. The rhetoric of manipulation and scapegoating finely tuned to keep you appeased has hit its peak thus far in 2022. They are all in on this. Playing your heartstrings and hoping you will fall for the perennial guilt trips. The narcissists took the money and set you up between them and the public. Medicine is politicised forever. People continue to die, directly or indirectly. And you remain their goat. Austerity 2.0 has triggered a fall in the institutes. *But, a new world is coming. It cannot be stopped. People are waking up. Staff are fed up of playing second game and the stupid card. They smell the stink everywhere and are striking. They are pulling back and seeing the ugly system and matrix of control where they are placed. Caring is a priceless commodity, use it wisely. You know your leaders are in on the game, the managed decline and orchestrated fragmentation and privatisation. There is no will to believe in you. You have to do it yourself. Position yourself and your weakened teams right in 2023. To those left in PCNs you are treading a dangerous path of easy dissolution. Merry Xmas and well done to all commentators for saying something.
I’m not sure that I agree with everything this chap says, but worth a watch.
You may want to share.
https://www.facebook.com/100081000847425/videos/6390490737630895