It’s a cliché but it’s true – general practice in this country is among the best in the world. Of course there are equally good primary care doctors in other countries, but the system within which we operate, our increasing ability to shape our services, our longitudinal relationship with patients and our responsibility for a defined population are among the features that can raise us above anywhere else.
Many of our forebears have created step changes in care that have spread worldwide. We have collectively left a footprint in the sand and continue to do so.
I am privileged to travel this land and visit so many inspiring teams in general practice. A practice in the North East where shared decision making with patients is the culture, practices in the North West who have created a musculoskeletal service for huge geographies, an inner-city husband and wife practice that has screened its entire hard-to-reach population for diabetes – showing a prevalence 8% above their neighbours. I could go on with many, many more brilliant examples.
However, I also see a minority, but a significant minority, of poor practice and poor behaviours – often alongside each other. Dirty, poorly equipped premises with poor staff practices, lazy attendance, a disrespect for patients’ time, off-the-scale referrals to hospital or A&E and a failure to ever collaborate with colleagues.
In one SHA, the ambulance trust could pinpoint several practices with double-digit times the 999 calls of other practices. These features are of practices you wouldn’t want you or your family attending.
My guess is, is if we are honest with ourselves, we can identify some practices in that category. Yet to date we have seen it as someone else’s problem – the PCT’s certainly, or the GMC’s if things get bad. Those bars are high. Revalidation and CQC registration will have an effect, but is it enough?
The greatest impact of poor practice is, of course, on the patients registered at that practice. However, the case I wish to put is that the impact of not dealing with poor practice is wider.
Firstly – on resources. Those practices receive equivalent, or in some cases higher, financial resources to others locally in terms of their primary care contract, yet use those resources less effectively. When money is scarce this means patients at better, more effective practices will suffer because the services they need may not be available.
Secondly, the over-use of hospital resources by under-performing practices and their poor contribution towards population health means the achievements of a commissioning group of practices are compromised. This again means limiting the flexibility that commissioning groups can create for investing further in primary and community care.
Finally, it devalues the currency of general practice itself. By definition secondary care sees the worst aspects of primary care.
This influences opinion, shapes behaviours and creates unfair stereotypes that are applied to general practice as a whole.
As commissioners, we will be responsible for holding providers to account for the quality of their services. This ability is undermined if we do not address the quality of primary care provision ourselves within our geographies.
I would argue it is our moral duty, to our profession, to our community but most of all to our patients, to grasp the nettle and begin that conversation.
That debate should not detract from the fact that the vast majority of general practice is of a high standard of which we can be jointly and justly proud. But it does now need to happen.
Sir John Oldham is a GP in Glossop, Derbyshire, and national clinical lead on quality and productivity at the Department of Health
The views expressed in this article are personal views