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How coalface GPs can change the world

A rebel alliance must be formed to combat the dark forces of 'Lord Cameron', says Dr Paul Barker.

Let me paint you a picture. Imagine for a moment that you are sitting in the dappled shade of a huge and ancient mango tree. Around you are many of the concoction men of Ghana. Proud upright men swathed in ceremonial orange and yellow costume. Their status is communicated in their bearing. Their eyes bright and piercing. Their ancient role is to kill infants that they believe to be ‘spirit-children'.

The process begins with a sooth-sayer. If she decides that the child is possessed of an animistic spirit, the parents will take the babe to a concoction man where a poison is administered and the child killed. The parents must not mourn the baby, for to do so may call back the spirit into the next babe.

I was there you see, at that world-turning event. When the ancient order of concoction men decided to stop killing children and spread the word through Burkina Faso and Ghana. I had malaria and didn't feel so good. But, and here's my point, I was really there. In the centre, watching things happen as the world changed.

Then I came home full of parasites and the evangelical zeal of change pulsing through my veins. The first head on collision was to discover that a man named Lord Darzi, a surgeon if you please; had, without consultation, made us spend 1 million pounds on a ‘Darzi centre'. Lovely cerise carpets and under-floor heating, but, not a bloody clue what to do with it. I was immediately reminded of another Lord, an empire-builder from star-wars. My father he certainly was not.

You see, I liked our relationship with the PCT when we communicated and engaged each other. Sure it was pedantic and pernickety, like a mother-in-law running a disappointed finger across a surface perchance to find dust. Sure, QOF was an exercise in ticking boxes and quantifying stuff. We nicknamed the next years round of changes as far-QOF. But, we made decisions together for good or bad.

Then came the GMC. As a miserable old man, I have to tell you that I could not care less whether Jesus or even Buddha have a walk on part in a consultation. Spirituality is ultimately important in understanding another's world view, for example palliative medicine.

You see, it seems to me, that we may have lost the plot. The world turns and we are at a precipitous time in primary care. Lord Darzi, like their lordships Voldemort and Vader is gone, thank goodness. But how ever did we let him in in the first place? I wonder, as I think back to the warmth of Ghana, just how much engagement we now have in the process of commissioning and providing services.

How much of a difference can we really make?

We have a government obsessed with minor-illness, clearly thinking - like Darzi- that this was all that we dealt with in primary care. The PCT builds million-pound shrines to minor illness and seem to forget about the rest of family medicine. I worry that the increasing irrelevancies of daily life in general practice, fragment our relationships with those organisations which may ultimately make a difference.

I learned whilst in Africa that we - as primary care physicians - are truly able to effect change. So, my challenge is simply this. Let us form together our own rebel alliance and really engage with the PCT and CCG's. Only through standing together and communicating effectively, can we hope to make a difference for our patients as well as defeating the next attack from the dark lord Cameron.

Dr Paul Barker is a GPSI in palliative medicine in Bournemouth.