Get on with it…

News and Comment from Roy Lilley.

Innovation is disruptive.  I mean proper innovation; troublesome to everyone involved and why people back away.

Uber; fighting in the courts, is really disruptive.  It pulls the rug on minicab companies, will decimate the Black Cab business, revolutionise how we travel, disrupt the licensing authorities, create thousands of jobs and is redefining food deliveries and holiday apartments.

The telephone killed the telegram and the mobile phone killed Kodak.  Innovation is aggressive.

Monday gave us a story, bounced out of the headlines by the Queen’s financial affairs, announcing the NHS was offering GP appointments on your smartphone.  Wow, innovation!

Disruptive innovation in action?  No.  

At best this is a pain for GPs, who will lose patients and have the mother-of-all bureaucratic problems to deal with.

This is not pugnacious, hawkish… like innovation is supposed to be.

It is a mess.  And, it’s a shame because it is really a good idea that’s been fudged, bodged-up and worked-around.

I live in Surrey… spend a lot of time in London.  It makes sense for the me to have primary access in London.  So, I thought I’ll register for this new service.  I qualify because I can claim to ‘work in London‘.

The small print tells me I will be ‘deregistered’ at my regular practice and signed up with the telephone service.

Fair enough.  However, from the address on the bottom of the web-site and a Google around, as far as I can tell this service is run from an address in London.  Sandwiched between a Pizza shop and an off-license?  Have a look and try not to laugh…

If I’m unwell at the weekend, in Surrey, I’m told I’ll have to ring NHS111 and hope they can fix me up with some sort of temporary local access.

Why can’t I be registered for App access and stay on the books of my local GP?  Because, this is not innovation, not a revolution.  Not transformative.  

It’s another layer of bureaucracy, cost and risk.  It’s duplication.  It’s a novelty but it’s not innovation.  This is not a brainchild at work.  It’s clunky.

This is an ingenious fiddle-about to try and drag primary care into the App-Age.  But it’s half baked.

The problem is this; GPs get paid by the number of patients on their books.  They don’t get a fee-for-service.  That is why the new Doc-in-yer-hand system only works if you up-sticks and register with the tele-practice.  

Tele-practice can’t do everything and there will be occasions when you’ll need a face-to-face consult.  It’s possible but I doubt the practice next to the off-license will have enough chairs in their waiting room for everyone who might turn up.

I’m really reluctant to put the boot-in but this, heroic attempt at modernisation, simply reveals how overdue it is for us to reexamine how general practice is funded and what a shambles the whole system is.

We can’t do clicks because of the bricks.  We have to pay to keep the overhead funded.  If GPs see a lot of people they could lose money.  Some do and go broke.  The alternative is pay them for what they do, not where they do it.

To make this work and work it must, we need a shake-up of GP payments and that cannot be left to the DH as they won’t take on the BMA.  This government is too weak.

It’s time for the Royal College of General Practitioners to show us they are about more than chains-of-office.  For the first time there is a digital-age chair running show; Helen Stokes-Lampard.

New payment arrangements, proper call-centre systems, multiple access to records, Amazon, Uber… I know that Lampard gets it  

Now we need her to get on with it.   


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