Dr Paul Charlson asks if GPs are ready for the cultural changes of a post-white paper world
Change usually divides GPs. For years enthusiastic schemers have toiled generally unsuccessfully in PBC groups while modern Dr Finlay types have sensibly been getting on with the day job.
The white paper has changed that. The former are looking ahead, while the latter ask what extra work there will be.
The new Government in waiting realised some years ago that the NHS was becoming too target driven, bureaucratic and Whitehall-centric. Any industry where production costs are rising much faster than production is bound to fail and this encapsulated the NHS. What was needed was cost control without excessive bureaucracy.
This is a difficult task but one more likely to be achieved by clinicians. They are closer to patients and more able to see how services can be redesigned to be better and cheaper. For instance, my own reflection of GPSI services is that they can be run successfully but savings would be greater if less data collection occurred. None of the services I have worked in has ever been near breaching the waiting times, yet every patient had to be monitored to ensure they did not ‘breach'.
So is the profession ready for commissioning? It will require considerable input from some of us even if we make use of the excellent professional managers and support staff that exist in PCTs – and, yes, they do exist!
Fundholding was embraced wholeheartedly by some practices, but things have changed. Firstly, fundholding was practice-based and therefore easier to manage. GP commissioning is consortium-based and it is likely that some groups will struggle to work together for a common purpose. Rewards will be paid to commissioning groups that achieve better health outcomes for their patients. Failure to perform by some practices will create tensions.
Secondly, the demographics of practice personnel have changed. There are far more part-time salaried and sessional GPs working in practices and some will not want to be involved in commissioning or to take on additional work left by partners attending meetings.
Practices will need to employ more locums, but how will they be encouraged and educated to work in a system that will certainly want to manage both referrals and prescribing?
On the other hand there may be other sessional GPs such as myself who are keen to be involved but cannot see an easy way of achieving it. Even if practices do not choose to be pivotal in the planning of commissioning, they will be involved in ensuring they work to the clinical outcomes developed by their local group.
As an enthusiast on the white paper I remain optimistic GPs will deliver, but to get there we all need to forensically examine what we do. To do this we need time. We will need to make use of other practitioners such as nurses, pharmacists and even physician assistants to ease the rising tide of urgent trivia that exists in primary care.
Cultural change is something that takes time and I wonder how long the NHS, in its current form, has got?
Dr Paul Charlson is a sessional GP in east Yorkshire and chair of the Conservative Medical Society
Dr Paul Charlson Dr Paul Charlson
