Salaried GP Dr Gunen Ucyigit argues that younger GPs shouldn't be shy in coming forward and that passion and a pair of fresh eyes can go a long way.
I was in the right place at the right time when the government announced it was going to let GPs commission local health services.
It’s something we had been doing in Bexley, south east London, prior to the publication of the white paper on health through the practice-based commissioning model (PBC) and we greeted the news because it vindicated what we were doing.
Practice-based commissioning
I know clinicians’ experience of PBC varied around the country but we were fortunate to have a PCT that didn’t simply pay lip service to GPs but really gave us the power to make commissioning decisions. That stood us in good stead for what was to come.
I was on a two-year GP leadership scheme at the time and involved in a variety of projects including the possible introduction of polyclinics and poly-systems.
It is funny how trends come and go but the essence of that work remains with the introduction of more community-based services so people can be cared for closer to home.
My involvement has since progressed to help with the redesign of older people’s services where the CCG is forging a closer working relationship with the local authority to promote greater care in the community.
I have helped facilitate the Productive General Practice programme for the NHS Institute of Innovation and Improvement and been involved in setting up Bexley Patient Council.
Younger GPs’ role
The Patient Council is unique to London and consists of 25 representatives who provide public representation to the CCG. They have been involved in a number of projects including the redesign of anti-coagulation services, patient transport and procurement.
I’ve also been involved in the procurement process of Improved Access to Psychological Therapies as well as helping improving patients’ nutritional requirements in hospitals via the Commissioning for Quality and Innovation programme.
It is extra work on top of my day job as a salaried GP but has given me a much broader understanding of the NHS and how it functions on both a clinical and non-clinical level along with all the checks and balances of the commissioning cycle.
This process takes time which is inherently frustrating for many GPs who are used to making quick decisions on a day-to-day basis. This is especially true when you start working on cross borough initiatives
I think younger GPs have an important role to play in the process and the indication is that many of them want to but are at a bit of a loss at how to get involved.
I appreciate this might raise some eyebrows but the pace of change is so fast that people are running to stand still with the NHS road map literally unfolding at our feet as we move towards April 2013
Enthusiasm and energy
I do think medical directors should be facilitating greater involvement including acting as a bridge for young GPs to receive the appropriate training and get them hands-on experience of commissioning even if they are observing.
The enthusiasm and energy is there and that could work very well alongside the more seasoned methodical approach of experienced practitioners, especially in areas like health informatics and new IT-led technologies
I can’t pretend I knew a lot about procurement before I started and I think any GP would secretly admit to being flustered when handed their first PCT finance report with all its figures and acronyms.
GPs don’t have all the answers which is why we need to forge a strong working relationship with officers moving forward.
The support that we receive post 2013 from non-clinical staff is an area of concern because staffing levels have been reduced and that inevitably means less flexibility in the system under pressure.
Our CCG structure is relatively small - comprising less than 80 people – so it will be interesting to see how this develops.
It is human nature that the few lead the many forward but I think there are many capable young doctors across the UK who want to contribute and more space needs to be made at the table.
This hasn’t been my personal experience in Bexley but does provide food for thought moving forward.
Salaried GPs
Another issue is ensuring salaried GPs like myself are kept on board.
I was interested to read a recent national GP survey which showed 44% of sessional GPs wanted to get more involved in commissioning but felt they were kept less informed than partners. Only 9% said they had a current role in a CCG.
As a result, we are looking at a specific event for sessional and salaried GPs as well as locums where they can find out more about commissioning and how to go about having more of a say.
I think it is also worth highlighting the fact that the majority of salaried GPs are female. It does raise the question of whether or not we are seeing the reflection of a national trend where senior management positions are still largely occupied by men.
I appreciate that nothing will be finalised until after authorisation later in the year but the more brains we have around the table the better.
* Dr Gunen Ucyigit is a salaried GP in Bexley, south east London.
