How the next GMC leader sees GPs

Interview - King's Fund boss Niall Dickson becomes GMC chief executive in January. He talks exclusively to GP.

Niall Dickson: the case for revalidation is overwhelming, but we must get the balannce right
Niall Dickson: the case for revalidation is overwhelming, but we must get the balannce right

Q: Is it important to be able to always see the same doctor?

A: For most of us, at some time I suspect it will be important - patients are pretty divided and for many young people it appears to be less important than for older ones.

But it does depend on individual circumstances and preferences - my own view is that we may underestimate its importance and that those patients who are fortunate in having a really good, supportive GP who understands them and their circumstances have something very special.

The fact that my GP treats the whole family is certainly something I value.

Q: How could GPs improve their media image?

A: We do need to keep this in perspective. Doctors in general, and GPs in par-ticular, are the most popular and trusted professionals in the land - journalists are viewed as lower than the lowest form of pond life (although recently they have moved above pol-iticians).

In the end, what matters is the service patients receive - the furore over out-of-hours working, the focus on pay and too much talk of contracts will act as a turn-off.

The more GPs talk about what matters to patients and the less they talk about their own concerns, the better the media coverage - but remember today's headlines are tomorrow's fish and chip paper (or I should say wrapping for my five fruit and veg a day).

Q: Is the revalidation of GPs necessary?

A: Yes. The case for revalidation is over-whelming. But we must get the balance right between appropriate checks and balances and overburdening busy professionals.

Revalidation will be built on a good system of appraisal and informed by the expertise of the RCGP and GPs themselves.

It should, of course, be part of a process for identifying and, if necessary, supporting poor performers and assuring the public, but revalidation is primarily about affirming good practice and providing insight and support for self improvement.

What GPs do and can do is more effective now than at any time in the past; their job is more complex and in many ways more demanding - it is too important just to leave quality to chance.

Q: How do you see the role of the GP changing over the next decade?

A: This is too complex a ques-tion to answer in just a few sentences.

At one level, 10 years is not very long and the GP of 1999 would not be so different from the GP today. But the pressures on the health service as a whole will be greater, and the growing challenge of supporting patients with long-term conditions will come even more to the fore.

It will increasingly be about managing a patient population and helping them to keep as healthy as possible - I am not clear how far it will go, but I suspect it will demand practices being more proactive, reaching out to patients rather than waiting for them to turn up when they have a problem.

If there is a change of government next year, it looks as if GPs will be even more involved in commissioning. It is likely that rethinking the role of the generalist will become important as medicine becomes more specialist and as patient records become easily accessible to a range of professionals.

Q: If you were in charge of the NHS for a day, what would you change?

A: It sounds boring, but I would align incentives, devolve decision-making, slash central budgets and put the patient experience (including clinical outcomes) at the heart of the performance management regime.

Q: Can the NHS survive the expected funding crisis?

A: I believe so, but it must become more productive and more responsive.

Q: What's the best piece of health advice you have ever received?

A: Apart from 'give up smok-ing before it kills you', it was when I was a student.

A doctor, the father of a friend, who was visiting our flat looked at my bandaged thumb - the result of a dog bite - and casually asked when I was due to go back to hospital. I said I had been told to return in four days and he said: 'Niall, if I were you I'd go back tomorrow morning.' I did and they operated on the gangrene in time to save my thumb.

  • Niall Dickson is currently chief executive of the King's Fund

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