Re-arrange the deck chairs!

Re-arrange the deck chairs!

Over the last month the so-called #NHScrisis has brought #GPs into the media spotlight. The BMA and CQC have responded, with a little help from Pulse.  And, of course, this is then reported in the general media as GPs being greedy, providing poor standards of care and being unable or unwilling to adapt to change. We all know that there needs to be transformation in order to cope with the current unsustainable primary care models and the acute shortage of GPs now and, given the ageing workforce, in the foreseeable future. These media reports are of course overly simplistic rubbish as, like all human beings, GPs need to be helped through change in order for it to be successful. They are not bad people who come to work to do a poor job or just to make money. It’s far more complex than that.

Primary care provides the first-point-of-access for advice, diagnosis and treatment for 90% of NHS contacts, but only receives 9% of the NHS budget.  General practice, like all other parts of the system, has seen an increase in clinical workload yet the failure to provide person centred care leaves many patients who suffer from long-term conditions falling through gaps in their care pathways.  The gaps lead to many of the health exacerbations that require reactive management.

Take a moment and think of a person whom the health and social care system has failed.  It may be someone with whose care pathway you have been involved: possibly  a friend or a member of your family.  Close your eyes and picture that person, listen to them as they share their ideas, concerns and expectations and think of them in the context of their family and community.  Diana passed away unexpectedly four years ago following a heart attack.  At the time of her death, she was receiving care from her GP, her local hospital, a specialist orthopaedic centre as well as the local health and social care community teams.  Diana’s early death was attributable to one of those gaps in the care pathway.  You couldn’t fault the individual health care professionals that provided her care, but the system meant that they worked in silos.  Someone needed to join the dots and see the whole picture. If they had, then perhaps she would still be here today to enjoy walking the dog in the park with me, her daughter.

Re-arranging the deck chairs on a potentially sinking ship won’t help.  To meet our expectations for personal care and tackle the increasing demand for the likes of Diana requires a change in how primary care is delivered.  The challenge is significant, for some as daunting as climbing Everest.  There are many obstacles to overcome, not least a dwindling workforce, increasingly complex technology and seemingly perverse incentives.

Where on earth to start?

Many staff are ‘caught on a treadmill’ trying to manage demand lacking the time to lift their heads up and consider what and how to change the way in which they work. In order to transform primary care we need to:

  • Challenge the media to stop demoralising an over-worked NHS workforce through uninformed criticism and denigration of GPs and all health care professionals. Ask that we all try to walk in their shoes and understand the pressures of meeting the needs of their patients
  • Understand the system and its issues from the users’ perspective
  • Enable change from the bottom up, that is clinically led and involving users and carers in designing the solutions
  • Create a vision for the future model of primary care with the buy in of all primary care members and system partners
  • Develop new training and workforce models, thinking beyond our own professional bigotries to harness the talent and potential of others to provide a primary care fit for the future.

We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right – one after the other, no slipups, no goofs, everyone pitching in.”

― Atul GawandeBetter: A Surgeon’s Notes on Performance