My colleagues have in this series of pieces for GPonline ahead of the special LMCs conference already outlined the real problems, pitfalls and challenges facing general practice – I want to use this final piece to talk about solutions and the decisions that GPs themselves must take.
I will start by repeating the very obvious issues we all face as GPs: not enough money, too much workload and nit-picking interference from organisations such as the CQC, which the recent BMA survey underscores clearly. The GPC has been leading the charge on drawing attention to these issues and the need for long-term solutions in funding, workforce and how general practice is treated are clear.
But we shouldn’t expect the cavalry to come over the hill suddenly: that is not how the lumbering behemoth of NHS England works. Also, we need to accept that beyond the real, detrimental impact of political incompetence, there are strong tides beyond the policies of government that are pressurising our profession.
Rising patient demand isn’t a short-term blip: our population is ageing and with it we will see more and more patients with complex conditions that need more of our time and resources. More generally, the population is expanding and with it there are different, expanding expectations as to what general practice should deliver.
The old Dr Finlay picture of the local GP pottering around all day in a practice that looks like a cottage means nothing to most of the patients coming through our surgery doors. Underpinning these stresses are of course the ongoing question marks about how we fund the delivery of services and challenges as to whether, with these tides enveloping GP services, we can sustain the current way general practice is set up.
Given this, we do need as GPs to start grasping the nettle of solving these issues. We need to become bolder and braver in saying no to some of the daft work that comes from NHSE: the BMA has produced good guidance on how to manage workload and every practice needs to use it.
All practices – and I realise this won’t be universally popular – need to give consideration to whether federating is a route to sustaining their service. My LMC has put forward a motion that directly instructs GPC to take the lead in tackling the crisis:
That conference believes there will be no solution to the crisis facing general practice until the following actions are taken, and asks that GPC take responsibility for initiating this plan:
(i) GPC leads a nationwide campaign to ensure that the workload of practices is limited to a level which is considered to be safe for both patients and practitioners.
(ii) LMCs are supported to encourage and defend practices which follow safe practice guidance.
(iii) Practices are given the necessary tools and support to work only within their safe workload limits.
(iv) NHS England commits to reducing local micro management and unnecessary bureaucracy and CCGs commission services which will address any surplus demand across the locality.
(v) Patient groups at a national and local level are given full information on this plan of action.
The intent of this motion is not to elicit some form of mass action, it is intended to be the start of safe working within a viable commissioned service where GP practices work together better and more effectively: in essence we start taking control of our own destiny.
As I said at the start of this piece, there is undoubtedly a need for politicians to play their part in correcting the parlous state of general practice. But as GPs we need also to start taking the initiative and facing up to the future: and that needs to start happening now.