Issues such as GP extended hours (where clumsy government handling of the issue and stubborn BMA behaviour pushed the issue to the wire) and the procurement of GP-led health centres (GPLHCs) encapsulate the tensions from which GP services will be shaped in the next 10 years.
Last month I chaired the 2nd National PEC Chairs conference - where PEC chairs from across the country meet and put speakers (national and from their own ranks) through their paces.
Following a number of questions from the floor about GPLHCs, I felt as chair moved to ask the audience how many felt that GPLHCs were a political tool and an unnecessary distraction designed to break the monopoly that GPs have in the market, or alternatively an innovative service model that would introduce required challenge into a stagnant market, and a stimulus for quality and access. The audience was pretty clear – more than three quarters supported the first interpretation. It is important to remember that this audience was the cream of the crop of strategic clinical PCT leadership, not BMA stalwarts.
Interestingly I find myself in the minority camp here. That is not to say that I believe the procurement process for GPLHCs has been well led. There are many examples of the inflexibility of the process leading to the imposition of solutions which do not fulfil local need, rather than the hoped for stimulus. The balance between leadership and driving change, versus blind imposition of “one size fits all solutions” has not been struck here.
However whilst I am a stalwart supporter of British general practice, I do believe that it has stood on its laurels a little too long and has not moved forward in some of the key areas that patients need it too. GP aAccess (advanced and extended) and the new GMS contract are but two examples.
Access to GPs
Patients of all types value good access to their GPs, but much of general practice has refused to acknowledge the variety of access needs, or that it is a marker for quality. Advanced access, whilst not without its problems offered practices some real tools to understand and manage their capacity. Unfortunately many practices responded by simply labelling appointments urgent or advance and restricting booking options. This simply brought misery to both sides – patients and practices. Extended access arguments aired the topic at a high profile in public and patient opinion appropriately won out despite the BMAs campaign making patients fear the loss of their local practices.
Similarly with the new contract, there has been widespread publicity demonstrating that many practices have not used some of the money to invest in infrastructure. This is not universal however, and there are beacons where practices have invested into staff, equipment and buildings and are delivering services with core GP values, around which they have built modern and outward looking, patient focussed services. These are frequently also the practices that are making the best running with practice based commissioning, showing us the way to the future, and building a firm foundation for the next phase of modern general practice.
There are challenges here for both practices and the DH alike. The DH must strive to deliver change in a way that grows that which is best, rather than runs roughshod over it. Similarly the current GMS contract is not fit for purpose anymore. Unfortunately, like its predecessor, it has GPs chasing multiple small pots of money, for schemes that do little to expand the care general practice could effectively deliver. If the Darzi Primary and Community Care Strategy wishes a coordinated and patient orientated service then the GMS contract needs to deliver significant supportive strategic levers for change. Similarly general practice needs to raise its sights and aspirations too. It needs to keep its core values, but must not cling to a protectionist affect that stymies its own potential for growth and a future.