Chris Lancelot: DoH must pay if it wants more from practices

England's national director of improvement and efficiency, Jim Easton, thinks that 'primary care (can) grow and build in a way that delivers the overall quality and financial agenda for the NHS'.

The GP Record, by Fran Orford: www.francartoons.com
The GP Record, by Fran Orford: www.francartoons.com

He said: 'It's a profound mind shift for people to be able to say they are prepared to go for quality to sustain the current level of funding. What are the mechanisms that drive people? Is there enough hunger?'

I hope I've quoted him in context, because in these few comments he has highlighted everything that is wrong with the DoH.

If he really wants an efficient, high-quality NHS then the DoH has both to listen to GPs and respect us, rather than ignoring us, bossing us about and constantly implying that we are not good enough.

Am I hungry for change? Like most GPs, I am sick of it: change for change's sake, just to prove that the government is 'doing something'. GPs are already overburdened: we have no spare time or energy for rescuing the NHS. Nor do we have extra funds available to purchase further staff time now the government has rejected the Review Body's recommendations, and with existing staff costs increasing. If the DoH wants more from GPs it will have to pay for it.

In any case, primary care is already by far the most efficient part of the NHS. It is time the DoH acknowledged this and used us as exemplars, because in reality it is NHS managers and NHS (dis)organisation that really wastes resources.

If the DoH wants efficiencies, then it should listen to what GPs are saying: stop the constant reshuffling of managers; stop unnecessary target-chasing and the incessant demand for more data. Reign in the PCTs. Stop employing external management consultants. Refine the National Programme for IT: it's poorly conceived, ineptly delivered, inefficient and costly. Stop wasting NHS money on PFIs and cease giving preferential tariffs to Independent Sector Treatment Centres and higher payments to Alternative Provider Medical Services.

Instead, start listening to practising clinicians who know what really needs to be done. Efficiency within the NHS is easily available - but it's a managerial problem not a GP one. GPs should be teaching the DoH how to improve, not the other way round.

The GP Record, by Fran Orford: www.francartoons.com

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