Fundamentally, the idea is that there has to be someone with whom the buck stops. Classically, I have even been phoned by patients even in hospital beds asking what is the diagnosis and plan. People need that level of background support, knowing there is someone in charge and someone accountable.
That doesn’t necessarily mean a GP. It does not even necessarily need to be one person. In our practice, we make sure that we hand the baton on when I am up in London so there is someone near.
What it does mean is that there is someone that a frail elderly patient can refer to. The complaint I have heard so often, especially in some inner city practices, is that some patients can’t identify with a particular health professional therefore they feel a bit at sea and if things go wrong, they feel a bit lost.
This recognition, the light shining on general practice in this way - some GPs might interpret this as yet another thing that GPs will have to do. I sympathise with that view. But you might see this announcement as being an upgrade for general practice, a recognition of our importance and a return to realising that the family doctor is the centre of care for patients after several years when a lot of the political rhetoric has been to work round them, circumvent them with NHS Direct and walk-in centres. GPs should regard this as an enormous vote of confidence.
We are seeing primary care being increasingly masterminded by CCGs. We know the local offices are not well resourced for primary care, don’t always have a good knowledge of the history of primary care. I think we are going to see a rapid move towards the primary care contract being run day to day by CCGs in all but name. The issue of how practices will do this will be agreed at CCG level so it is all the more important that CCGs are connected to the frontline.
It is more of a challenge with a workforce that is increasingly part-time. But that doesn’t mean the service should adapt to the changing workforce – what it means is that the changing workforce should keep to the principles that good patient care entails. Having a level of accountability is essential.
Dr Michael Dixon is chair of the NHS Alliance
