I have had the people who work in general practice on my mind recently. At this time of especially heightened clinical engagement, it is easier than ever to forget that good healthcare is delivered by teams.
In one week, three things - a personal experience, an interview with a British Medical Association spokesperson and a survey of practice nurses - have left me as convinced as ever that we must seek models that develop and reward everyone in the healthcare team. Staff and campaign organisations should think calmly and seriously about private companies (and public and third sector providers) competing with the practice model.
First, the personal experience. On a Friday I rang our surgery about a medical emergency concerning a family member. I was anxious and panicky but the receptionist was calm, able and confident. She was caring in an unfussy, understated way, asked me about symptoms and assessed urgency. I was impressed with her skill and on reflection I realised she had been as important in the process as the excellent GP who saw us later in the day.
In short, this is not someone whose job is simply to take messages and book appointments. They seldom make policy headlines, but we can all give examples of how highly valued by the public are the knowledge and skills of support staff, normally gained informally. Other staff, including medics, get it too. I can listen to NHS medical director Sir Bruce Keogh on this subject all day long.
Upbeat and positive about my health service, I was therefore more than ready on the Monday to be upset by a report of an interview on the Today programme:
"The BMA has voiced concerns that the new database of confidential patient records can be accessed by NHS workers who need no professional qualifications.
"The co-chair of the GPs' IT sub-committee Dr Paul Cundy argued that such alleged practices 'breach all common concepts of privacy and confidentiality.'
"He added that the BMA was told the system would include 'role-based access control' which would define access rights according to an employee's role in the NHS."
Dr Cundy told the programme: "Healthcare assistants, who are nothing other than trained receptionists or telephonists, are actually being given access to the clinical records. Healthcare assistants are people I'm sure who are perfectly competent but who don't have any clinical qualifications, who are not regulated, not a member of any specific body and who are trained for specific tasks."
He does a good job gritting the debate and annoying both ministers and NHS Connecting for Health. But is this really about clinical qualifications? Are people without one - presumably trusted employees in other ways - more likely to become dishonest or idiots or both around medical records?
How are we to react to what he is saying? Perhaps by running into the street screaming "I can't believe this. Perfectly competent trained people who are not members of a professional body might work with my clinical records as their role requires. Alan Johnson, you crazy fool, why are you doing this?" Well, after you.
Dr Cundy's language is also telling. He might be one of the good guys who values and champions his support staff. But if he is, it takes a really bad day at the office to come up with "nothing other than trained receptionists or telephonists". Support staff do not share this lowly view of themselves and they hate being told they are at the bottom of the skills heap.
In 2006, then health secretary Patricia Hewitt appeared to suggest in a speech to Unison activists that healthcare assistants were unskilled. Given her audience this was so stupid it had to be unintentional. In fairness, before the booing got going she realised her mistake and apologised - rather convincingly. It is probably too late to book Dr Cundy for this year's Unison health conference - but here's hoping.
Hearing me sound off on this, someone sent me bits from a recent National Audit Office report on NHS pay modernisation and general practice rules:
"The new general medical services contract aimed to extend the use of other staff in the GP practice, but does not stipulate how they should be employed. This has resulted in variation in how practice staff are employed and treated. Practice nurses carry out a significant proportion of the [quality and outcomes framework] work and local enhanced services. In the focus groups [with about] 100 practice nurses in London the NAO found nurses' morale is being affected by the new contract.
"Nurses believed that they had an increased workload which has helped increase GPs' income without getting any personal reward. The NHS Working in Partnership programme recently highlighted that GPs fail to reward nurses for their work on the quality and outcomes framework. Some of the practice nurses reported they were working without contracts and only a minority were on NHS Agenda for Change contracts."
Then, as if to drive the point home, John Lewis announced all its 69,000 employees will get a bonus of 20 per cent of salary. But don't go to work for a shop. Why not become "nothing other than" a receptionist or nurse at your local GP practice?
If practice - one model of private sector provision - is not working for all staff (including salaried GPs) and for every local population, then perhaps other private sector providers should get a go. Let's be tough in choosing in the interests of local people and don't get conned by private sector miracle workers. But don't oppose companies in primary care simply because they seek to make a profit. What's the difference between the profits of a healthcare company and a GP practice? Not much. For this reason, I can't bring myself to foam at the mouth at the likes of Virgin Healthcare. Indeed, companies like it might be better at valuing everyone in the team.