Reforms need tweaking, not abandoning

Just as GP brought to a close its look at general practice in 2010 and beyond, another vision for the future has emerged.

In this version PMS will have disappeared and GMS will be funded through capitation and a basic practice allowance. Meanwhile the national IT spine for shared records will have been abandoned in favour of locally held data. Less of a vision and more of a sense of déjà vu perhaps?  

These ideas for ‘retro primary care’ came from respectable sources. In a speech to the NHS Alliance conference last week, GPC chairman Dr Hamish Meldrum, himself a PMS GP, said there were too many types of contract in primary care and suggested abolishing PMS. In what he stressed was a personal view — which is a bit like Tony Blair saying he personally favoured abolishing the NHS — Dr Meldrum suggested that PMS practices switch back to a reformed GMS which would be based on a basic practice allowance with capitation.  

Meanwhile, an internal review document from Connecting for Health (CfH) has emerged which says that locally held health records hold fewer risks to patient safety and confidentiality than hosting shared records on a national spine.  

Both Dr Meldrum’s speech and the CfH report reflect concerns that all is not well with recent innovations, but this does not mean that the best strategy is to throw out much of the work of recent years and revert to the previous situation. There were significant reasons and goals behind the new GMS contract, PMS and shared records. If the strategies to achieve these are not working we need to look at making changes, not throwing out the achievements along with the mistakes.  

PMS and GMS may well need to merge but does this mean abandoning the ideals of the global sum to return to a previous system with inequalities? Instead, the goal should be finding a way to make the global sum concept work — turning back is likely to create more not fewer problems. Equally, if shared data can improve patient care, efforts should be on finding a solution, not backtracking. Primary care has moved on too far for a simple turnabout. 

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