This week has seen a predictably polarised outpouring of glee, hope, fear, tears, threat of retirement and prophesies of heaven and doom in all their glory! The new Scottish GP Contract ‘Blue Book’ proposal is out for all to read, chew over, digest, spit out, or worse.
Of course, there is a risk. There will always be risk in any new, previously untested radical change. But on reflection, there seems to be an attempt to avoid top-down, one-size-fits-all implementation.
The ‘mission-statement’ style document seems vague and lacking in detail – some of which will be essential to address. This can be unsettling for some looking for straight-forward, well-developed instructions and solutions. Looking at the opinions expressed on twitter, and some fora, especially by GPs in smaller remote and rural areas of Scotland, there are a lot of concerns about loss of autonomy and control, and natural protectionism.
We need those values to maintain the motivation and energy towards quality care for our communities. But we also need to balance those protective instincts with the need to adapt to the changing medical, health and social care environment and needs. A less directive approach opens the doors to local negotiation and service organisation, to be more involved in reconfiguration of holistic community services – including mental health, other allied healthcare professionals, social services and so on – but without some of the trickier Human Resources loopholes.
This contract is also about culture change, towards a more collaborative, safety, quality improvement, and person-centred approach to health and social care organisation. This has been a developing mantra across Scotland in recent years. The proposal reflects our changing society, and is an opportunity to reset our assumptions about what makes effective, safe healthcare, from a financially incentivised business-based model led by GP bosses, to a more collaborative network of professionals coordinated by a clinical team lead.
Hard though it may be, change and improvement requires breaking some old bonds to be able to make new ones, and sacrificing some direct control to be able to collaborate more. This contract proposal is a catalyst for GPs to reconsider whether our assumptions and beliefs are benefits or barriers to improvement.
On the surface it seems to offer a more level playing field, giving GPs more choice in the balance between clinical and managerial, planning and leadership roles without solely being based on financial risk and incentives.
Clearly this is a work in progress, and I hope we can be a part of developing it as a profession, rather than just having to live with it – more control rather than less.
I just wish they’d get a move on with some details before we have to vote on it!
Dr Cathy Welch is a GP on the Isle of Arran, Scotland