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Only GP leaders can hold the NHS together

Guest editor Dr Georgina Brown argues for an NHS led by GPs with an end to wasteful peripheral services

Sitting in an on-call room at 3am, I'm seeing patients sent by Scotland's out-of-hours triage system, run by NHS 24.

I've seen a week-long bout of constipation, two sore ears, conjunctivitis and an enchanting old soul with 15 minutes of resolved abdominal pain (told to attend so she could ‘just keep herself right'). Risk-averse triage at its best.

Then there are the house calls – a one-hour target for a 22-year-old with diarrhoea, yet four hours for an elderly woman who can't move her left arm after falling downstairs. Aren't these patients supposed to be triaged by highly trained clinicians?

Surely, as our front-page story highlights, this ‘all things algorithm' approach is damaging. Are NHS Direct and NHS 24 really using scarce resources appropriately?

This is hardly the only example of the NHS wastefully complicating and fragmenting our health service. In my area, I am not allowed to prescribe NRT, but expected to refer to the NHS stop smoking service instead. Yet, as our story shows, costs at these services are spiralling.

Imagine going back to basics and toppling these infrastructures, obsessed with fracturing, analysing and pigeonholing what we do. What would be left? A gold-standard primary care system. A dedicated, efficient, adaptable workforce. Local GPs aware of local needs and more than capable of leading, developing and ultimately commissioning services with the right support.

Scottish health secretary Nicola Sturgeon envisages an end to the UK-wide GP contract. With the decentralisation of healthcare, many are impatient that national negotiations don't pertain to local need. With a new UK Government comes changes some may welcome and others reject. GP commissioning and federations are under the spotlight, along with a welcome recognition of GPs as key professionals ready for senior responsibility.

So are you ready to lead? Six years ago I joined my LMC after listening to two speeches at a GMS contract road show, one from a respected LMC secretary (featured this week among other GP leaders), the other from a modest GP negotiator – now GPC chair! These are grass-roots GPs who have become leaders. GPs know how to deliver excellent, cost-efficient primary care, responding to change but avoiding needless fragmentation of care.

We undervalue our ability to lead. GPs are at the centre of the NHS, and should be pivotal to its design. Sounds too simple? As Confucius said: ‘Life is really simple, but we insist on making it complicated.'

Dr Georgina Brown is a GP and LMC member in Glasgow. She would like to thank those GPs who contributed to this issue.

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