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Balint and budget sheets

A bunch of GPs gazing up their own bottoms. This was the unflattering description painted by a colleague on hearing of our newly created Balint Group. Michael Balint was a Hungarian émigré born in 1896 and seduced into psychoanalysis by Freud and a series of analyst wives. He worked with GPs in the f1950s and it was then his seminal work ‘The Doctor, his Patient and the Illness’ was published; his ideas strongly influenced the founders of our own Royal College of General Practitioners.

A traditional Balint Group consists of 6-12 doctors with 1-2 leaders and meets regularly for an hour or so over a year or more. Why not? I asked myself setting off after a long winter’s day in the surgery to make a round trip of forty miles to sit in a Baltic Quaker meeting house in my overcoat like a member of Alcoholics Anonymous group sans tea and cigarettes.

My mind, as I drove through the rain and motorway spray, was preoccupied with the day’s news about CCG budget allocations, funding formulae that failed and how deep went the razor cut of top-slicing for specialist commissioning and public health. The sum left was “our” budget for health services provision for our county. In one way the allocations seemed generous compared with other public services – an increase overall of 2.3% but don’t forget to end the year with a 2% surplus, said the NCB, as a slight but expected sting in the tail.

“Who has a case?” our leader asked. The doc presenting the case, without notes, tells the story of a consultation, the description of what happened between the doctor and the patient. Not a typical case presentation but something that is continuing to occupy the mind of the doctor presenting leaving him puzzled or angry, frustrated, irritated or sad.

After a prolonged silence I hesitantly describe the story of a young man so disabled by social anxiety that he cannot sign on for job seekers allowance; ostensibly a welfare scrounger this man’s existence revolves around fear of his next Atos assessment. I see him briefly every week, don’t change his meds., feel guilty about seeing him so frequently but for him it seems to help. The group reflect and consider I’ve created dependence on the one hand or a therapeutic “doctor as medicine” relationship on the other. No solution but it’s good to talk.

It’s still raining on the motorway and I’m buffeted overtaking trucks but I feel satisfied – the evening’s discussions in some way a balm to both commissioning and consulting. There’s a little red light winking on and off in my occipital lobe, distracting me, worrying me there’s something not quite right with the public health allocation. Never mind, I say, switching it off, tomorrow will do.