Our diarist had lunch with the health secretary before the white paper came out last week.
A Day in the Life of
I thought for once that as the ‘diarist’ for Practical Commissioning I would treat you to just that. A page from my diary. My day. Last Thursday to be precise.
06.45 Go for quick sprint round the block to fight off incipient man-boobs.
07.30 Drive from Carlisle to NHS Cumbria’s central office in a disused mental health ward in Penrith.
08.00 Attend summit meeting about a commissioned service that has failed a quality assurance programme. The director of public health asks how I will manage this in the future under the locality model.
09.00 Chair the GP leads meeting prior to our Clinical Senate meeting – this is the successor to the PEC and is where the individual localities come together to hold a corporate line about the big issues. Normally our chief exec wanders in with a cup of tea and chews the fat but once again I am ambushed by the surprise presence of the imposing chair of NHS Cumbria. Who clearly is also an early riser, a military man; he briskly updates us on the SHA’s response to our arbitration hearing with one of our acute trusts. He looks us each in the eye, talking about the need for solidarity in adversity.
09.30 Abandon the normal agenda of the Clinical Senate to rearrange the furniture, learn our lines and generally be nervous in anticipation of the arrival of the Secretary of State for Health, Andrew Lansley, who is coming to spend the day with us in Cumbria.
10.30 Secretary of State duly arrives and I welcome him to the Clinical Senate. I expected robes, he observes, and sits at ease while private secretaries et al distribute themselves around the room. He lets us talk about our own localities, their successes and challenges, the support functions they need and their similarities to the model he proposes. The way I see it, he says, is that you are best placed to be making the commissioning decisions for your patients. If you push your trolley-load of health care to the check-out you do not want the PCT leaning over your shoulder and saying “You can’t have that or that” and taking stuff out. You know and understand budgetary discipline. You can be responsible. We ask him when the White Paper will be with us. He smiles. Soon, very soon. Unchanged? Virtually unchanged, he assures us again with a firm smile.
11.30 Follow SoS ministerial car through sun warmed Lake District under Blencathra, past Keswick and Grisedale Pike wind beside Bassenthwaite Lake and on to Cockermouth to visit revolutionised community hospital with pods housing flooded out GPs’ surgeries.
12.30 Lunch with SoS. While he is being interviewed by the BBC I press members of his entourage for information about the department and its ambience under the new boss. It’s been a very busy couple of months, I’m told, he’s very clear about what he wants and very determined to achieve it. I understood the treasury had concerns about his plans and the White Paper would be delayed? No, he will not be dissuaded. Another, in smart checked shorts, signalled by her Blackberry consults it intently and grins, White Paper out on Monday, it’s definite.
Over lunch we talk about the future role and place of Public Health, separate to PCTs and more within local authorities. He is keen for pharmacies and pharmacists to play a more active role in people’s health management, the diagnosis and treatment of acute and chronic conditions, that they are hugely competent and hugely underused, that their national contract is ridiculous and should be determined locally depending on their role. That such groups feel marginalised by the power being given to GPs and that needs to be handled.
13.30 Another television interview where he tells the media that GPs are best placed to make decisions. I take my leave and drive to chair the Carlisle Locality Board where said GPs are being grumpy and argumentative in spite of the evidence that our personal oil tanker of emergency admissions has started to turn and we have a fall in number against a national increase of 12%.
16.00 Meet Carlisle’s new MP who is very interested in the changes and wants reassurances that we are going to maintain healthy and viable local hospitals as well as commission from the independent sector.
17.00 Arrive late at said viable local hospital to chair weekly clinical leaders meeting with locality GP leads and their consultant equivalents – the hospital’s clinical directors, Stress again that though we are in a formal dispute with them (on which the SHA is supposedly arbitrating) we need to maintain strong clinical links as we are still going to be here with our patients when the dust settles.
18.30 Miss call from the Financial Times who want an interview about our locality model and its similarities with the proposed national model.
19.30 Arrive home and crack a Carling even though it’s a school night.
20.00 Spend half an hour on the phone to the FT about NHS Cumbria and where we’re going.
Later to bed and thinking about tomorrow. I’m duty doc in the practice for 15,000 patients. Fantastic. An easy day.
Peter Weaving is a GP and locality lead in Cumbria
Andrew Lansley faces the press