Let primary care dish out the advice for once

The Foundation Trust Network report on back office efficiency - Quality, Innovation, Productivity and Prevention (QIPP) National Workstream: back office efficiency and management optimisation - proposed that huge NHS savings could be made by dismissing practice receptionists and managing all primary care appointments in national call centres.

The GP Record, by Fran Orford www.francartoons.com

It swiftly earned itself the reputation of 'most ridiculous NHS suggestion ever presented to a government'.

Fortunately the idea was dismissed by ministers. It was clearly unworkable. Receptionists do a lot more than just make appointments: they filter, prioritise and redirect. They know the neurotics, the bullies and the blaggers, and won't let them clog up emergency slots - a call centre could not possibly have this level of knowledge. And how would a call centre cope with reorganising the day's appointments when a GP phones in sick? Probably by re-booking them all for two weeks later.

Like its title, the QIPP report was risible. Yet it was also dangerous, because superficially it sounded plausible to those with little understanding of primary care.

We've had Lord Darzi (an ultra-specialised surgeon, of all people) advising on primary care organisation. We've had non-clinical PCT managers insisting that GPs should not give immunisations or perform health checks without compulsory extra tuition. The previous government thought PCTs could organise out-of-hours care much more efficiently than GPs - then discovered, very expensively, just how wrong it had been. Everyone and his dog seems to think that they can run primary care better than we do.

And yet it is universally acknowledged that primary care is by far the most efficient part of the NHS. GPs are effective gatekeepers for secondary care, economical in our use of staff and competent organisers. Why do so many outsiders think they can tell us how to do primary care better? Is it because, like Lord Moran, they consider GPs to be 'failed hospital doctors', and therefore that our management must necessarily be equally 'failed'?

If so, they should think again. Primary care is efficient: secondary care and the wider NHS aren't. If anything, we should be advising them, not the other way round.

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