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Will we ever reach nirvana?



What is the future of general practice? I don’t mean this as a vacuous philosophical-type question. I mean literally, what is the future model?

It seems there are those slogging it out in traditional general practice set-ups, and those who by ambition or design find themselves involved with pilots and ‘vanguards’.

If you want shiny multidisciplinary teams of the future working with pharmacists and physician associates, give us the money and we will do it

I heard about one such vanguard site this week. It sounded like general practice nirvana. Yes, it had 30,000 patients – but all the job vacancies were filled and there were no problems with recruitment. They had an on-call hub with social workers, occupational therapy, physiotherapy, district nurses, health visitors and GPs all in one room. A call comes in and is filtered through to the most relevant team member. Only if there is an outstanding medical issue at the end is it passed to the GP.

This is team work – genuine team work. Not shirking responsibility because ‘it’s not my patient’, ‘you saw them last’, ‘you’re on call’, or because you’re all burnt out. An expectation that everyone mucks in and is equally responsible, whatever their role. Interestingly, it was still busy. This isn’t a cushy life. But the GPs are doing the medicine, and everything else is filtered out.

Unsurprisingly, this sounds very appealing. I don’t have a problem with working like this. It makes sense to use the skills and resources of other colleagues. Imagine we no longer had to hang on the phone to speak to the duty social worker. Imagine a return to the days when district nurses and health visitors were based in the same building, and you could chat to them in person instead of voicemail. I’m sure this is a smarter way to work.

But guess what – it’s a million miles away from what is happening for most of us. This approach needs money and it needs time. You can’t do this when you are understaffed and overstretched. You can’t do this type of change on a shoestring budget when your CCG is in the red and propping up the local acute trust. You also can’t do it if no one tells you that’s what they want you to do.

Why does the Government seem to have such a massive problem with general practice, yet refuse to nail its colours to the mast and say ‘this is what we want instead’. Why can’t it end the uncertainty that is putting younger doctors off? End the agony for the rest of us? And be prepared to put its money where its mouth is?

If you want shiny multidisciplinary teams of the future working with pharmacists and physician associates, give us the money and we will do it. But until you’re prepared to set out your stall, try not to undermine and slowly destroy the rest of us. Otherwise we will wonder if there’s a hidden agenda.

The road to hell may be paved with good intentions, but the road to nirvana cannot be littered with the burnt-out bodies of GPs. Unless general practice is supported better there will be no GPs left to run these new organisations. We will achieve enlightenment, then be plunged straight back into purgatory.

Dr Zoe Norris is a GP in Hull