Viewpoint: Who will fight to save primary care?

At a time of challenge and difficulty in the system where should our ambition be? To simply survive day to day? To keep our heads above the flooding torrent?

Or do we, at the same time as treading water and keeping going, aim to do something different to re-route the water, stop it from washing away everything in its path and leave behind a soggy mess?

When I was young I went to a college where we provided beach life saving patrols to our local area in the summer. So I learned to swim in the sea. The number one lesson was: ‘Don’t rush to swim towards the calm bit of water you can see ahead because when you get there it will be just as choppy as the water you are swimming in right now.

‘Learn to swim in choppy water. To make progress when the waters are cold and rough you need to be resilient, skilful and keep your eye on the destination.’

There is so much turbulence now. A General Election coming that is too close to call… whoever takes the helm is bound to mean changes for health… services under pressure… recruitment across the system in crisis…

Primary care professionals need to decide where they stand

Primary care, and the staff who work within it, have choices to make about whether they are architects and builders of something new or simply allow themselves to get washed away.

The response from primary care to my October post about my mother’s care has been fascinating. Those who felt it was a call to arms to fight the status quo and build something better, and those who were simply too tired and too worn down to do anything but reply that my mother’s care was safe at least - safe in the smallest sense.

Whose job is it, then, to fight for primary care? The Five Year Forward View for the NHS describes a compelling vision for primary care but who designs the road map to get us all there?

Will CCGs do it? Is co-commissioning primary care the way forward? It seems to be the only option around. CCGs seem keen, as do GPs, but is that because we will be good at it or because of the lack of capacity in area teams to do anything?

What about the conflicts of interest?

We as a CCG have struggled with the idea and whether it is right. We can talk about conflicts of interest policies to make it safe and I am sure they will help but the public do not understand the NHS architecture and why should they? It is absurdly complex.

They see federations of GPs providing services, CCGs of the same GPs commissioning care, and we can tell them it is all governed and transparent but when I do that I see blank looks and disbelief on peoples faces.

I see risks to the clinical leadership in CCGs too, because the easiest way to deal with the inherent conflicts are to simply reduce the influence of the GPs within CCGs - but I believe doing that risks a return to PCTs. Our strength and success is built around the real partnership between managers and clinicians and the public working together to change things.

Will those in the vanguard be allowed to innovate?

The vanguard initiative to develop the new models of care will be interesting. To succeed it must allow local areas to work to their own agendas, and resist the temptation to impose structures and timeframes to meet national and political imperatives.

The changes envisaged are huge and to be successful it must be clear to everyone participating what the task is, what the challenge is, what the future should be, before we talk about structures and payment mechanism. We should know how to do this - function first then form.

Most importantly, we have to develop a system that safeguards quality and continuity for those who are frail and have complex problems, provide timely and accessible acute care and creates an environment that will attract doctors nurses and other health professionals to choose it as their career because it’s rewarding, challenging but not exhausting, and is fun. Is that ambitious enough? I think so! Time for more swimming…

  • Dr Pleydell is GP and healthcare commissioning lead for Hambleton, Richmondshire and Whitby CCG

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