Dr Gavin Ralston: GPs must nail colours to the mast and back working at scale

As part of a week-long series of blogs for GPonline by GPC members, GPC negotiator Dr Gavin Ralston says GPs can't sit back and watch while the profession is re-shaped around them.

I'm looking forward to this year's LMCs conference on 18 and 19 May. The first reaction to that admission is perhaps that the author frankly needs to get out a bit more.

While that is very possibly true, I am genuinely looking forward to this year's conference in the fair city of Edinburgh. My dad used to call it 'Auld Reeky', but that term might be better used for my home in Birmingham these days, sandwiched as it is between the car parks that masquerade as the M6 and the M5.

My anticipation is mixed with a degree of trepidation as rather than lurking at the back, cocooned in my anonymity, as a member of the GPC executive team I will be wrenched out of my comfort zone to play a more active part this year.

Future of general practice

One of the newer features of the conference are the themed debates taking place on Thursday afternoon, where the voting slips and the medical press can take a short break and perhaps a more thoughtful and in depth discussion can take place. One of the sessions this year, to which my colleague Dr Simon Poole - the very erudite GPC policy lead for this area - and I will be doing a short introduction focusing on future models of general practice.

I have been pondering what we might say, assuming anyone chooses our meeting, of course. I might start by saying: 'Good choice', and not just because of Simon's elegant turn of phrase, but because  this is one of the most pivotal areas in the development of general practice.

The current model of general practice would still be recognisable to anyone transported from the early 1980s to now. However, if the GP was the one being exposed to a spot of unexpected time travel, they might notice one or two changes.

While being jolly glad to no longer be on call overnight at the end of a traditional very non-mobile phone, everything else in the practice garden - now a carpark of course - is not quite so rosy. Demand has gone through the still-dodgy roof, the patient population has changed, getting noticeably greyer and presenting with as many problems as they seem to have chronic diseases.

GP workload

What about the incessant meetings, the tsunami of electronic tasks, scans and path results, never mind all this new regulation; the rather Orwellian sounding CQC and of course revalidation and the horror of the e-portfolio. I think a request to go back to the 1980s might not be long in arriving.

Our time travelling doc probably would have returned before he or she had a chance to note that our government had also decided that we need to be more accessible to our patients and provide a more integrated service to boot.

So what can be done, or more to the point what can we do, as frankly I can't see anyone improving this situation for us, unless we take matters into our own hands. The old model of lots of little practices has worked well, but to give us real resilience and enable us to change the way we work, we need, in my opinion, to band together at significantly greater scale, ideally in a super-partnership or a very strong and robust federation.

This does not mean that every practice has to do this: smaller practices still have a place and we should not sacrifice the flexibility that gives general practice its strength. But for our sanity, our patients and to have a voice in a system that will otherwise redesign itself around us, we need to have the tools in place to allow GP practices to evolve on a larger scale in the areas where that is desperately needed. So I'm looking forward to talking about this and putting forward the case for LMCs and the GPC to get out a large hammer, some significantly strong nails and nail their colours to this particular mast.

Full coverage of LMC conference 2017

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