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I really think they’re out to get us. Which could be GP protectionism or GP paranoia. Whatever – I’m certainly feeling glassy eyed, having just read the long-term plan, which I hadn’t planned to do, and which is long. Read right through it and, I think, seen right through it.
It starts OK, pointing out that the NHS is well designed, efficient and scores high on satisfaction – this last point illustrated (honest) with the example that diabetics are twice as likely to get a leg amputated in Germany, and not just because the waiting lists are so long over here. My mate Jürgen is hopping mad about this.
Then it talks about us being mandated to work in primary care networks, which is fine because a) this comes with loads of cash, and b) we’ve already been huddled together in federations, collaborations, joint ventures, alliances and various other thesaurus entries for ‘network’ for ages, because everyone keeps saying that’s the only way to survive. So, just like when QOF started, we’ll be paid new money for doing something we’re doing already.
So where’s the problem? Read on, and a common thread slowly emerges through the euphoria.
At face value, it sounds great that there will be new teams looking after care home residents, community crisis services delivering NICE-approved management within two hours, urgent treatment centres in every locality, 111 directing patients to pharmacies, ‘population health management and predictive prevention’ and screening services so cutting edge that illness is all but banned. Less work for us GPs, hurrah!
But then there’s the emphasis on ‘digital’, ie algorithms and docbots. And the lowering of threshold for cancer referrals, which I predict will make our gatekeeper role redundant – especially alongside the aspiration that patients with red-flag symptoms will be able to self-refer to ‘rapid diagnostic centres’.
And it’s at this point that you catch yourself laughingly saying, ‘It’s almost as if they don’t need GPs at all!’ Then you stop laughing. And you realise, they don’t need GPs at all. Suddenly, it all makes sense. GPs – that is you and I – are now seen as dispensable. True, buried deep within the document there is the statement: ‘We still believe we need a net increase of 5,000 GPs as soon as possible and are committed to this.’ But, with the sudden disappearance of the 2020 deadline, this is the clearest backtrack yet on that promise. And it certainly doesn’t stop the protectionist/paranoid concluding that only a little more backpedalling might result in a new target somewhere in the region of minus 33,000 GPs.
I can only draw two possible conclusions. One, that Matt Hancock et al have absolutely no idea what GPs actually do. Or, two, that they know exactly what GPs do, but think it worthless. Neither is a comfortable notion. Because, either way, GPs are dead and buried. We are decomposed, compressed and fossilised. We are the sediment that now provides the foundation to a shiny, digital future. We are the bedrock of the NHS.
Dr Tony Copperfield is a GP in Essex