Adrian Hilton is a conservative academic, theologian and educationalist.
If we’re all good boys and girls this Christmas, the Department of Health has some treats in store for us next year. Santa Hunt (Jeremy Claus?) is promising improved access to our GPs seven days a week, which is sure to put a smile on a lot of faces if not thousands of votes in the ballot box. That old fashioned, corner-shop style of Primary Care is just no longer fit for purpose, you see. We all now want 24/7 access to GPs like Tesco gives us to microwavable creamy carbonara.
And so surgeries right across England are being ‘encouraged’ to think about working in consortia to enable longer opening hours, and Clinical Commissioning Groups (CCGs), which currently manage various aspects of Primary Care, are to be given much broader powers to re-design GPs’ Terms of Service in order to force these co-commissioning consortia into existence against anticipated resistance.
“Great!” you might shout. “I’ll be able to see my GP whenever it suits me. Absolutely marvellous.”
Not quite. This is one of those gifts where the packaging and wrapping might just be more thrilling than the contents.
Co-commissioning refers to CCGs sharing with NHS England the responsibility of planning and commissioning re-designed GP services. ‘Commissioning’ in the new context means “This is what we want and if you GPs won’t supply it we’ll take the money and pay someone else who will.” That’s to say, it’s a unilateral re-writing of the GP contract. Seven-day access is a current political imperative and so GPs are being ‘invited’ to explore collaborative working as a means of enabling this. It’s a bit like asking the turkey to help choose the best butcher’s knife for carving. The really helpful ones might also volunteer a neat three-step basting technique.
It is very easy to forget (as Jeremy Hunt recently did) that we already have 24/7 access to a GP via the ‘Out of Hours’ service. It’s not as popular as it might be, primarily because it provides access to ‘a GP’, not ‘my GP’. ‘My GP’ is one of the principal NHS traditions we cherish – you know, the kindly and compassionate doctor we prefer to see above all others when we visit the surgery because they know us and we know them, and they only have to look into our eyes to understand what’s wrong. They’ve seen us through tears and trauma, nursed us with minor ailments and held our hands through major surgery. They even gave us a hug when we were bereaved. It’s that personal knowledge and trust which takes years to develop and is so very precious. Even Health Education England (HEE) recognise the importance of this relationship. Writing their 2015/16 Workforce Plan, they say:
“England’s General Practitioners occupy a unique and pivotal position in our health system. The first point of contact for most people concerned for their health or the health of a loved one, their status as trusted advocate or source of immediate care, has made them the person that the public are most likely to think of as ‘their doctor’.”
But ‘their doctor’ is about to get very busy with other doctors’ patients. The problem with forging consortia of surgeries is that ‘my GP’ will be spread thinner, forced into a rota to cover seven-day working, and become less accessible to me because he’ll be preoccupied with other surgeries and seeing their patients. Sure, it’ll be easier to see a GP at more convenient times, but at the expense of the ‘my GP’ aspect of Primary Care.
I really quite liked the guy who used to run the local butchers, with his array of freshly-carved meats strewn across his counter, attentive to the quality of every cut. And I loved the couple who ran the fruit and veg store as well, with their tales of market visits at 4.30am to select the best seasonal produce. I was saddened when they closed due to the Tesco effect, but I guess that loss was compensated for, in a way, by 24/7 convenience. And yet I feel sure I’ll miss ‘my GP’ more. I guess modernisation is inevitable, but we really do need to reflect a little on the tradition we’ll lose.
HEE is tasked with the job of recruiting GPs and they’re planning to increase the training intake by 15 per cent next year in order to meet the co-collaborative need. You have to admire the optimism. Despite their strenuous efforts, the numbers recruited to GP-land have fallen over recent years due mainly to the job becoming ever more unpalatable as the public are promised more and more from less and less. A shrinking workforce cannot expand its output without cutting services, and young doctors aren’t overly keen on conveyer-belt care. Perhaps HHE should start by persuading turkeys to vote for Christmas, and once they’ve mastered that hominoid culling, move on to medical graduates. Should that fail, HEE do have a Plan B, and you read it on ConHome first.
I predicted a few months ago that they’ll soon be importing GPs from Europe – and so they are. In the same Workforce document, HEE write:
“If partners require the GP workforce to grow more quickly than is achievable through newly trained supply, or at a greater scale, then they would have to consider alternate sources of supply such as retention schemes, more return to practice than is currently planned, and international recruitment of qualified GPs.”
It’s the obvious solution to the GP manpower crisis since there’s little prospect of General Practice becoming a favourable career option for our home-grown medical graduates any time soon.
Stay tuned and next week I’ll be predicting the Christmas lottery numbers.