Interview: Integration key to NHS survival, warns Sir John Oldham

Sir John Oldham, Labour's new integration czar, tells Marina Soteriou why the NHS will not be sustainable without integration.

'Everywhere I travel in the world,' says Sir John Oldham, chairman of Labour's commission on integration, 'I genuinely come back and think how lucky we are to have the general practice we have in this country.'

The DH's former national clinical lead for quality and productivity for England has had many high-profile roles alongside being a practising GP in Derbyshire.

His latest role, after retiring from general practice last year, is chairing Labour's independent commission on whole-person care. The commission is due to make policy recommendations to the shadow cabinet next year. It will outline how the party's aim of integrating heath and social care can be achieved.

Sir John says change is needed because the current health and social care system is not sustainable.

'Some 70% of cost and activity in the system are from people with multiple conditions which cross organisational boundaries,' he says. 'They are the most frequent people who end up as emergency admissions and it is just not great for them, their families, or their care.'

Profile - Sir John Oldham
  • Became a GP in 1983 and retired from general practice last year.
  • Chairman of Labour's independent commission on whole-person care, which will help shape the party's policy pledge to integrate health and social care.
  • DH's national clinical lead for quality and productivity, focusing on urgent care and the management of people with long-term conditions, up until 31 March this year.
  • Created and headed up the National Primary Care Development Team, launched in February 2000, to improve access to GP services.
  • Received OBE for services to patients in 2000 and awarded a knighthood for services to the NHS in 2003.

 

Fame

For most GPs Sir John will be best known for leading the National Primary Care Development Team (NPCDT), set up in 2000, to boost access to general practice.

But for others, he will be most famous for appearing on the Today programme, BBC Radio 4's flagship news and current affairs show, to talk about his idol David Bowie's single, back in January. He was invited to go on the show - where he said Bowie was like 'the Da Vinci of this century' - after he tweeted enthusiastically about the single.

'It was completely weird. For about a week or two afterwards if I was giving a speech I was introduced primarily as a David Bowie fan and then what else I had done in medicine thereafter,' he says.

A passionate lover of live music, he still fits in a gig whenever he is overseas giving a talk.

One of his most memorable gigs was in Chicago on a work trip eight years ago.

He had to persuade a taxi driver that he really did want to go to one of the 'less salubrious' parts of the city.

'I ended up being dropped off at a door with a sign above it, but with graffiti sprayed on it, thinking this is a really dumb thing,' he says. 'But I knocked on the door and the most fantastic (blues) music came out.'

Culture change

Sir John calls for a culture change across the health and social care sectors, for people to stop working in silos and to 'reignite a shared purpose' from the patient's point of view, rather than from the different organisations'.

He is adamant integration has to be achieved without more structural change. 'The last thing the health and care system wants is another imposed massive change,' he says.

He adds: 'The haemorrhaging of knowledge from this reform has been greater than the other ones I have known.'

Primary care

Although practices continue to struggle with a rise in workload, Sir John insists it is a problem across the whole of the NHS.

'Wherever you are in the system, demand is increasing because of the demographic drivers.'

'Life will go on,' he says when asked what effect the new GMS contract will have on the profession.

Even after his failed bid last year to become the RCGP's president, he still isn't tempted to say what GPs want to hear.

Poor performing practices are a barrier to integration, he says.

'I have been quite shocked at the negativity that exists to general practice in many parts of the system, both in the NHS and social care. When you dig a little further that is because there is a small proportion of people who create that impression.'

He advocates dealing with these practices through the CQC registration process. 'When there isn't enough resource to go round that resource can be utilised by other practices much more effectively.'

Access

He predicts GP access will be 'raising its head again' because some of the ground gained has been lost.

But he says the legacy of the NPCDT is that he is still approached by GPs who tell him they are offering all patients appointments on the day they want, with the doctor they want.

Career

When given the opportunity, he waxes lyrical about UK general practice. 'For me it (general practice) is truly the jewel in the crown of the NHS and I would not change my career choice if I had my time again.'

GPs may not like everything that Sir John says but if integration is going to work, there can be no room for the silo mentalities he opposes.

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