The final element of sustainably is that we should be of greater value than cost.
This is of course a tricky one as value is a perception. In the case of general practice it's the perception of two groups, our payors and our users.
Our users' perceptions are formed based on more than there experience of general practice. In a society where Sunday shopping is the norm the perceived value of a five-day general practice service is reduced.
In the case of my practice we are open every hour of the GP contract, and have been for years, but patient satisfaction with opening hours has declined according to the patent survey.
Our payors' perception is also a complex, multi-factorial view, since our payors are now our CCG colleagues. Their perception of our value will include feelings about how our performance impacts on their psyche.
In the case of my practice our new model of access and drive to change things may be perceived as either a threat to the CCG vision or an ally to modernisation.
If practices are to be sustainable they will need to manage the value perception, promoting the outcomes of care, sharing accomplishments and publicising services in a way that few traditional practices have done in the past.
Perhaps we could all do with taking a leaf out of the private sector play book and spend a little time on managing our message.
- Dr Chris Mimnagh is a GP in Liverpool co-director of clinical strategy at the NHS partnership organisation Liverpool Health Partners