Ben was CEO of Nene CCG for 8 yrs. He was a Director of an acute trust and has run national improvement programmes. He is a founding director and Principal Consultant of Ockham Healthcare, which he describes as ‘a platform for change’.
There is a big gap. This gap exists between how general practice understands its need to change, and how the wider health system needs it to change. And at present there is very little that is constructively being done to resolve it.
General practice understands its need to change based on two things: income and workload. Drawings are down and workload is up.
The two are not entirely unrelated. As the drawings for each GP partner are calculated based on a split of the total ‘profit’ of the business, as income falls practices tend to go one of two ways. They either reduce the number of partners or number of staff to keep drawings at the same level, or they accept a reduction in earnings and maintain staffing levels.
As result GPs are either paid less or overworked. And in many cases it is both. GPs feel that the current situation cannot continue in the direction that it is currently going. Some just want to retire and be done with it. Others are too young and want things to change.
But very few have signed up anywhere in this to evolving the business of general practice. They want to continue doing the work they do now. The notion of specialisation is something that most GPs turned their back on when they chose to become a GP in the first place. But the reimbursement for core general practice is what is being eroded, and is what will continue to be eroded. The government want more and more for less and less from the core GMS/PMS contract, and that is not going to change any time soon.
At the same time district general hospitals are coming to the realisation that growth is not the answer, that total income is not king, and that a shift of services out of hospital is required if the health system is going to be able to live within its means in years to come.
I was talking recently to an acute trust Chief Executive about this. He understood the problem really well. He talked eloquently about how he was working with community services and social care to shift services out of the hospital setting and into local communities. He gave some great examples of how care was now being delivered in different ways, such as the hospital funding healthcare at home services.
I asked him where general practice was in this in new way of working, and what role it was playing. He looked at me blankly. I explained the key role that general practice could be playing, with different practices building areas of expertise in different specialties, driving down variation and linking with hospital specialists to enable much more care to be delivered at the first point of contact the NHS has with each patient. He said no-one in his organisation really understood general practice so they had to get on with making the change happen regardless.
This is the reality. Those outside of general practice look upon it with bewilderment. It feels like a magical world of impenetrable acronyms, like GMS, PMS, DES, LES, and (worse) MPIG. There is no mechanism for engaging general practice as a provider in the conversation about system change. As a result change is happening regardless of general practice, not because of it.
So this is the gap. GPs want change for their own survival, but are not particularly interested in models beyond core general practice. The wider system wants to change but is clear neither on the role of general practice within this change, nor on how to even engage it in the conversation. There is a very real danger that general practice and the wider system will change in isolation from each other, and not in a way that solves each other’s problems.
CCGs are uniquely placed as organisations that understand the need for system change and understand general practice. We must step up as organisations and provide the direction the system needs. General practice in this country, the envy of the rest of the world, presents a huge opportunity to become the platform on which the health and social care system is developed, so that it can tackle the issues of ever increasing demand, a rising, aging population, and an explosion in long term conditions. And it is up to CCGs to ensure this opportunity is taken.
This article was first published on September 22nd, 2013 on www.ccginformation.com
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