open space

Published: 26/09/2002, Volume II2, No. 5824 Page 25

The current system of general practice - a collection of individual small businesses - often results in inefficient use of resources and inequality between staff. It is time to change, says Martin Pallett

is not it time that all general practice staff, including doctors, were directly managed and employed by the newly developing primary care trusts? Such sentiments may have been regarded as heresy even 10 years ago, but with a more managed primary care service fast emerging, surely it is time to consider how this can be achieved as fast as possible.

After all, we already have personal medical services pilots, new forms of salaried GP employment and the prospect of a new contract being agreed.Most people probably believe this is the direction in which we are heading, and many would welcome it.

Most patients and the public would probably be astonished to discover that general practice in a city such as Plymouth is managed by 40-50 separate organisations or small businesses.

Despite the best efforts of PCTs and practice managers to co-ordinate workload and services throughout primary care and general practice in areas such as bulk purchasing of vaccines, these arrangements are bound to involve waste and duplication.

How would a more uniform and managed primary healthcare service be a step forward? If primary care is to be modernised, the variations in the ways practice staff work, and their conditions, can surely no longer be acceptable.Currently, the hours, grades and holidays of reception and nursing staff at one GP practice may be worlds away from those of another practice in the same town.

One practice will award its nurses the nationally recommended pay increases, while another will not.Some invest heavily in nurse training and development, and others provide very little.These differences have a substantial impact on staff, who may be unable to move elsewhere, and on quality of care.

Surely there should be certain minimum standards that all practices are required to meet.

I was brought up to believe that the NHS was about universal standards, and assumed that this also applied to staff employment practices. I believe basic standards need to be met before staff can feel valued and trusted.

A growing number of newly trained doctors seem to be nervous about taking on the responsibilities of partnership and managing staff, and do not want to take a stake in owning surgery premises.More and more GPs are looking at part-time work and job-shares.The way general practice was established in 1948 cannot meet public expectations now.

Doctors would welcome the opportunity to focus on their clinical work rather than take on the increasingly complex and risky role of employer, with all its legal responsibilities.The diverse roles GPs may be required to play in general practice can put them under great stress.Many were never trained to manage staff.

You may say this is the job of practice managers.But in many practices their role is ill-defined and there are variations in the way they work.Practices still see themselves as small businesses.

Doctors still expect to be involved in the day-to-day management of staff and buildings, however competent their manager.

The current arrangements may suit some, as a practice can be run very economically.The involvement of GPs in management, and the relatively low salaries of practice managers, help make British general practice good value for money.Also, it may suit some to be able to present inadequacies in local health services as failings of individual GP practices rather than of local primary care organisations.

But it is no longer acceptable for practice staff to be denied the benefits other staff enjoy by being part of more uniform NHS organisations.

GP practices should be an integral part of the PCT, not just under its umbrella.This will have huge implications for the development of PCTs, and will represent something of a revolution.

Let's start planning now.That way it will be possible to recruit and retain the calibre of staff needed to deliver the government's modernisation agenda.

Martin Pallett, a former practice manager, is now general manager, Cornwall Blind Association.