The room was packed by the time I arrived. I took a seat and got my sandwich out. Lunch on the hoof is an invariable part of general practice life, especially on days when you’ve somehow got to squeeze in a meeting alongside the usual work.
The GPs in our area have been getting together like this for a few years, ever since the Department of Health started making noises about us “working at scale”. Elsewhere, groups of practices have merged to become “super-partnerships”; others have joined with their neighbours in looser “federations”. But we’ve never quite managed to get anything off the ground locally. We rather like being distinct individual practices, providing long-term personalised care to our patients, and have never seen the point of creating a behemoth in which this could easily become lost. Even if we had, it’s doubtful whether there would have been the time, energy and money to drive it through. We’re all just about surviving the day job.
That has changed with the advent of the new GP contract, which came into force this month. It promises the first real-terms increase in resources for general practice after a decade of cuts. The only caveat is that we have to be part of a “primary care network” (PCN) – the new term for groups of practices working together. Hence the room being so crowded for this latest meeting. Suddenly we need to act.
We’re not entirely starting from scratch. Last year we managed to settle on a name (Three Valleys Healthcare) as well as a management-speak strapline (Traditional Values, Modern Thinking). But now we really have to do something.
The first task will be to appoint a clinical director – there is funding for a day and a half per week for someone to lead the PCN. It’s up to us, apparently, how we choose them. An election seemed a good idea. Half an hour later we’d become mired in indecision. Should it be one vote per practice? Should votes be weighted by list size? What about one vote per partner? But then what about salaried GPs? And nurses? And practice managers? This may be a taste of things to come.
The funds will be welcome, though. They’re centrally dictated – to be spent on allied health-care professionals such as pharmacists, physician assistants and social prescribers (people who help patients whose problems are social and economic in nature). Extra doctors would have been good, but never mind. In theory, these new entrants will be able to relieve some aspects of our workload, helping to stem the alarming loss of GPs from burnout. That’s always assuming we’ll be able to recruit. Nationwide, demand for these professions is set to soar.
I had to leave before the end – my afternoon clinic was starting. I left my colleagues wrestling with the vexed question of how to ensure member practices get fair shares of access to new services. We’re set to meet monthly until the summer in order to iron out these kinds of details. Arriving back at my practice, my first two patients were already waiting. I wondered whether the gains from employing new allied staff might simply offset the time and energy invested in running the show.
Other concerns have been raised. Covering populations of 30,000 to 50,000 patients, PCNs might be attractive propositions for the private providers that have already taken over so many chunks of the NHS. Personally, I doubt they’d be interested. There’s precious little on offer for management costs. In that respect, “working at scale” bears all the hallmarks of a traditional NHS venture, operating on a shoestring and the goodwill of staff who have nothing left in the tank after years of austerity underfunding.
Readers of my last column will be pleased to hear that my terminally ill patient Nell’s appeal succeeded; her partner, Arif, has now been allowed to join her in the UK. I called round the other day and was delighted to get no reply. It was a beautiful sunny day, and they were out enjoying some precious time together
This article appears in the 10 Apr 2019 issue of the New Statesman, System failure