Advisor: Right, the thing is – GPs are pretty unhappy that they’re being asked to work too hard.
They’re tearing their hair out, and steadily falling off their perches.
So, the narrative is that we’re increasing GP numbers.
Now, this may not be strictly true, yet. But we are trying.
Just tell them the number is rising – there was one day last spring when we were in the positive.
So just say it’s happening slowly. So slowly, GPs may not have noticed. No one will fact check you.
MH: Gotcha, more GPs. There are more GPs coming.
We’ll get them from abroad, we’ll find them in cubbyholes, we’ll flush them out of the woods. No problem. I can be vague and non-specific, but eternally optimistic that we’ve turned the situation around.
What else am I supposed to be talking about?
Advisor: A few promises about improving workload wouldn’t go amiss.
Something about reducing beaurocracy, streamlining processes, reducing pressure – nothing specific.
We haven’t got any answers for this – so keep to generalities. You could say that PCNs will help.
MH: Oh yes, PCNs – remind me what are they again?
Advisor: Remember our chat last week – where I outlined the move to force practices into groups?
The problem we’ve had was that GPs were so overburdened and overwhelmed that they started handing back their contracts.
It’s been an absolute nightmare, and it’s costing NHS England a small fortune.
When GP practices fold, we have to pick up the pieces, and pay GPs extortionate amounts to bribe them to work in the toughest areas.
We quickly realised that we can’t be doing with sorting all that out.
So, the plan is that we band them together – practices, I mean.
You take four or five small or medium sized practices, and offer them cash incentives to join a PCN.
We’re then walking the practices along a steady road towards mergers.
Have you seen the PCN maturity matrix? It explains it all pretty clearly.
1. Sell the dream, promise the world and get GPs to ‘believe’ in the vision.
2. Get them to share staff, jointly employ people and share IT.
3. Fully integrate their workforce, IT and estates.
4. We haven’t said this explicitly, but when one or more of the practices folds due to staff shortages or financial instability, the remaining GPs are left holding the can.
It’s proving reasonably straightforward so far. The GPs haven’t really noticed, they’re generally too stressed.
MH: But hold on, don’t GPs value their autonomy? Don’t they like organising their own practices, around the needs of their local population?
Advisor: Yes and historically they have. But the problem is, we’re haemorrhaging doctors.
We can’t afford to be left responsible for the patients.
So, PCNs are non-negotiable.Group practices together to cover populations of 30 to 50,000 patients.
Add a few nurse practitioners, pharmacists and paramedics into the mix.
Then even if half the doctors go, hopefully we can still have some sort of service, even if it’s much worse overall.
MH: Isn’t there any other way to reduce the demand on GPs? How about charging patients?
Advisor: Don’t go there. Political suicide. The only way we can go down that route is if we have a big sell out of primary care to private providers.
We’d need a lot of cash to sweeten the deal to the public. And to be fair, the only way we could sell out would be through getting GPs to work in larger organisations.
And we’re doing that with the PCNs anyway. So, it’s all to play for.
MH: Great, got it. It’s the future of general practice. The answer to all their problems. There’ll be pots of gold at the end of the rainbow.
Advisor: Yes, perfect – just remember, be vague about money.
There will be more of it, but don’t ever say exactly when or where. We don’t want the GPs to find it.
MH: No problem. The PCNs sound like a great idea – I love it!
Being an economist myself, I know GPs are pretty useless at things like efficiency.
They just don’t understand economies of scale. They need us clever folk to show them the way. But, can PCNs actually improve patient care? How do patients find the vanguard practices which have merged?
Advisor: Ah, hmmm, well…We’re not looking too closely at those finer details.
You see, all the evidence suggests that patient satisfaction levels are reduced at larger practices.
We haven’t looked closely at whether there’s improvement in patient care either.
The thing is, patients don’t always know what’s good for them. Just like the GPs. They need us to show the way.
MH: Right, never mind. As long as it saves us money in the long run.
Advisor: Yes, that it will. Also, it means we can have a bit more control over GPs. We’ve had real issues with the independent contractor model.
Too many small businesses to deal with. We just couldn’t tell them what to do easily enough.
MH: Yes, I see, that’s always difficult. I know we’ve been kicking ourselves for decades over the out of hours fiasco.
Advisor: Don’t worry Matt, we’ve got that in hand. Give it time…
Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West