When I first asked my team to prepare a ‘good news’ issue they looked at me aghast. How could we – in all conscience – pull together a cheery issue of Pulse, when there was so much to be gloomy about?
General practice has come a long way
It was a fair point. General practice is probably in one of its darkest periods since the inception of the NHS; I’m hearing regular reports of partners quitting their posts to go sessional due to intolerable pressure.
The latest figures show a mere 5% of Department of Health funding going into core general practice. The actual spend may be up 1.5%, but this is still an inexcusably pitiful allocation to a part of the health service that is so important.
But in the darkest times it is even more important to search for chinks of light.
General practice has come a long way. If you took Dr Finlay through your practice today, he would be amazed at the range of care provided and the extended roles that nurses and others are performing.
He’d probably be thrilled to learn he’s not on call every evening and weekend and that, if the stars are aligned, he can transfer work to a specialist mental health crisis service, a dementia intensive support team or palliative care specialist.
Once you have told him about that box in the corner able to bring up patient records at the touch of a button and the vaccination schedule that prevents many life-threatening diseases (epiglottitis, anyone?), he might need a lie-down.
Now, I’m not pretending everything in general practice is good – I know better than to try to tell you that – but it is not wholly bad either. Let’s be honest, if you stuck general practice on a psychiatrist’s couch at the moment then it would probably need a serious course of CBT. There are endemic problems in the profession that urgently need to be addressed, but the main thing that needs to be re-established is simple. Hope.
GPs are innovative, resourceful and pragmatic. Adequately funded and left to its own devices the profession could deliver even more of the impressive clinical changes we have already seen.
But general practice feels undervalued, under-resourced and under siege. Even the most optimistic of GPs can feel on some days that the whole system is conspiring against them.
Some enlightened NHS managers recognise this. You can read some glorious examples of CCGs giving GPs more freedom and funding and allowing them to better advocate and care for patients, in our issue. But these are the exceptions rather than the rule, even though this approach is vital for the NHS to get itself out of the huge financial hole it finds itself in.
This year should mark a turning point. NHS England has an opportunity radically to streamline GP payments and free practices from useless performance targets – by scrapping the QOF and the unplanned admissions DES for a start. It should install structures to ensure GPs have enough time with patients, looking at new ideas such as emergency overflow hubs or caps on consultations.
But most of all, it must appreciate that its most precious resource is the goodwill of GPs to make a difference for their patients. Squander this, and it will take a lot more than an upbeat issue of Pulse to fix.
Nigel Praities is editor of Pulse