General practice is in crisis. It is on its knees – not enough appointments, not enough doctors or nurses, colleagues retiring early, registrars looking at other options.
And another wave on the stormy sea has just hit us with primary care networks (PCNs). I have been a GP for 31 years, I am still here and love the job – but I am a threatened species. Without general practice, the gatekeeper will be gone and the dam will burst and the NHS will collapse.
Here are 10 areas where something can be done to save general practice.
1. Remember it is about patients
We must remind our GP leaders, politicians, CCGs, CQC, health boards and other purveyors of process that we need less time with the system and more time to see more patients. Using the NHS as a political football has to stop, constant change has to stop. Now it’s PCNs – how many times have we been there before with health authorities, FHSAs, PCGs, PCTs and CCGs?
2. Offer partnerships
We have forgotten that the current model, which we have all known, allows innovation and autonomy, unlike a salaried service, which is not sustainable except through direct employment by our funders. We need to encourage partnerships so that we can pass the baton on to new GPs.
3. Referrals are good
A good doctor refers because they know their own limitations and that a patient needs expert input and investigation and may be seriously ill. Good care of patients does not mean using a referral centre. Stop creating hurdles to prevent us referring, such as an ever-changing e-template and e-referral system, refusing paper or faxes and weekly changes of individual specialty referral pathways and organisation names.
4. Halt the mandatory training epidemic
We have training for everything - from domestic violence, to fire extinguisher use, from manual handling to a protocol how to wash our hands. We have medical degrees, postgraduate diplomas, experience of ill people that is unique. Seeing patients is what the NHS should be about. Completing this online drudgery is supplementing the appraisal ‘tick box’ mania to the point of paralysis. All it is doing is feeding the beast of bureaucracy.
5. Tackle paperwork
We need more time with patients (this is becoming a recurrent theme), but now we are deluged by tasks to provide information and stare at a computer screen all day. Everything from coding and filing out-of-hours contacts, patient letters asking us to do tasks that a doctor should not be involved with, such as re-referring. We serve the computer, not the other way round.
6. Don't be distracted by digital
Apps, e-consultations, changes in registration for a live video chat, never mind continuity of care. Except that when you are really ill, you need an assessment, face-to-face with someone that knows you and makes a judgment based on many factors as well as a physical examination. Digital has its place for a few - and often the worried well. But someone still needs to see those patients who are severely ill, with complex needs and multiple co-morbidities and above all to provide continuity.
7. Franchising has to stop.
It should either be the NHS or private, but not both. The NHS is left with the complex and challenging, when it would benefit from all available funding to maintain a comprehensive service.
8. IT needs sorting
This is a no brainer. We should pick one, integrated system, which becomes owned and run by the NHS, not franchised, and is used by every healthcare worker, GP, hospital, out-of-hours provider, pharmacist, dentist or physiotherapist and so a complete patient record is immediately accessible to all including the patient. Suddenly the filing and paperwork reduces from medication, letters and multiple tasks and then we will not need fax machines.
9. Leadership and resilience
The bandying about of these terms is nauseating. GPs have demonstrated resilience to cope, but those that are left are at breaking point. We need leadership, not attending leadership courses. We need our leaders to stand up to politicians for the sake of the NHS and our patients.
10. Maintain hope
I say to my trainees that the future is good. The NHS goes through peaks and troughs. We are in a trough, but we should be proud of the NHS, now in its 71st year of providing care to all at the point of need. In relation to global healthcare, the NHS is almost unique. We need to be role models to inspire the next generation of GPs about what is an amazing career this is and the very important role we play in our communities and the NHS.
- Professor Charlton is a professor of undergraduate primary care at the University of Leicester and a GP partner, trainer and appraiser in Solihull in the West Midlands.