In my role leading an LMC I visit many practices, and at each one I usually detect a siege mentality, It’s not quite the Blitz in general practice although some days for many I think it must feel like it.
We can and must act and we must act now
Our whole way of life as professionals, as patients, and as carers is under threat and it is time for us to do the right thing. In some of the darkest hours of this country very few politicians thought Churchill would succeed and believed that invasion by the Nazis was inevitable. General practice is in meltdown and GPs are voting with their feet – resigning early, emigrating or changing career. We can and must act and we must act now.
We must agree a vision of what general practice needs to look like in the future.
We must prepare our story for patients, for carers, for our colleagues and ourselves.
We must be ready to explain all the options and their implications.
We must consider the option of a ‘post train crash’ world of general practice that needs to looks much better than the current solutions being developed.
We must not have a shooting-ourselves-in-the-foot ballot – the first step is to develop a clear vision.
We must develop a good list of actions to take and address all the possible implications.
We must ensure we outline the ways and means so that all of our colleagues can be prepared for the possible consequences of each step of industrial action.
We must be ready to play our ace in the pack and when we threaten undated resignations we must mean it.
We must resign in significant numbers by helping our colleagues who are fearful by describing what dealing with all the unintended consequences will look like for them.
We must support colleagues who fear dealing with commitments to patients, carers, staff and premises.
We must explain how all of this can be sorted.
We must avoid a short-term victory followed by another major conflict within a generation.
We must make a compelling case for an independent Health and Social Care Corporation (HCC) to run our health and social care system. This body will need a 25-year charter and will need guaranteed independence from day to day interference from Westminster politicians. The HCC will need to explain the costs of a modern integrated health and social care system – where ‘primary care’ and ‘secondary care’ are terms confined to history. When the HCC reviews the current situation the politicians needs to allow it to make a diagnosis and to develop a prescription, which needs to be administered in a timely fashion.
The HCC may argue any or all of the following, that:
- The internal market has had its day
- Bureaucracy, regulation and inspection is overcomplicated and is failing patients, carers and professionals
- The purpose of computer technology is to serve patients not to performance manage, to over-complicate, to over-medicalise and to hide behind
- You get what you pay for and this means a we need to invest a greater percentage of GDP in healthcare and to have an honest debate about co-payment for social care and health care costs
- Demand is fuelled by supply, and that most of the world rations access by ensuring that those who can afford it pay something each time they use a service for wants rather than for needs
Canvassing opinion by our ‘leaders’ is all well and good, what we need to do is support the authentic and brave leaders determined to find a way forward. We don’t need to keep doing surveys to see if anyone is brave enough for the fight that lies ahead, the brave and the good have a clear vision and they will always be followed.
We must act now.
Dr Chris Hewitt is a recovering GP, having resigned from the performers list on December 31 2015. Chris now works full time as chief executive of Leicester, Leicestershire and Rutland LMC and is the elected representative for Northamptonshire, Leicestershire and Rutland on the GPC. You can follow him on Twitter @lmc_chris.