For the first time, since God was a lad in short trousers, we’re losing more GPs than we can recruit and one in three posts for specialty GP training don’t result in a GP joining the NHS.
With amazing resilience, practices are muddling through. ‘Care guides’ replacing GPs, offering Zumba classes for back-pain and flower arranging for depression. Sounds like fun?
Four hundred and fifty GP surgeries have closed in the last five years. That’s about 1.3m patients marooned. The latest wheeze, hospitals are ‘buying’ GP surgeries in an attempt to control flow into secondary care.
There’s more. Half of practice premisses are not fit for purpose.
There’s are a lot more I could dig up. All depressing. Pretty-well nothing is going in the right direction.
The plan seems to be, the industrialisation of primary care. Up-scaling. Crash it all into one place, either physically or virtually.
Practices had already cottoned on to that and were setting up Federations. Now, that’s all being kick over and Networks are the name of the game.
Consultants and lawyers will make another fortune and practice managers will have even more to distract them.
I looked back with great affection to the time my life was saved by our GP. He drove my Dad, with me in his arms, in his car, to hospital, at midnight.
He lived up the road, in a big house. We lived in a flat.
He had a car in a garage, we leaned our bikes against his fence.
We wore jumpers, he wore a waistcoat.
He had cufflinks, we rolled up our sleeves.
He had a tie for everyday. On high-days and holidays we did-up the top button on our shirt.
He wasn’t one of us but he lived alongside us. He was there for us.
His waiting room was his dining room. We sat around a huge, mahogany table. A mirror-glass shine we never dared to touch. His consulting room had French windows opening onto a manicured lawn where standard roses stood to attention, in rows of military precision.
My Dad cleaned his windows but he treated us, particularly my mother, with enormous courtesy. Gentlemanly, polite to a fault and he listened.
Family practice, the heart of our health service.
It’s all gone now. I’ve been allocated to a GP, a stranger, with a special interest in old people. I think I’d rather visit the vet than visit them and admit to being old.
Living in the past means you might die there. Let’s move on.
What to do about GPs? Like any other business model that’s run its course, it’s running into decay but we dare not run out of ideas.
The first decision; it’s make-yer-mind-up-time. Nationalise or privatise?
Over-time, bring all practices into state ownership; gives us more control on costs and a better chance at uniformity of outcomes.
Or; they are contractors now… privatise them properly; sell GPs an NHS Family Practice Franchise, with an operating blue-print, minimum standards and fixed premises requirements.
Downscale primary care, stop pretending GPs can do everything. They are not mini-hosptials. GPs unplugged, in the shopping centres, high streets and around the corner. Get back to family practice.
Hospitals have imaging, diagnostics, pathology and everything you need to get patients through the system. Fund hosptials to do primary care and leave the GPs to do family practice.
Adopt a digital first policy. Everyone, who can, has their initial contact by smartphone video… this creates room to deal, properly, with the ones that can’t.
Longterm conditions? Manage them from NHS call-centres. Populations of around 300k using AI, algorithms and if needs be, video consultations with specialist nurses and a visit to the GP as the last resort.
Will it happen? Dunno. Something has to. There’s a global shortage of care staff, it takes too long to train a GP and there are too many of us and not enough of them.
Throwing money at this problem won’t fix it. It’s time to throw around some ideas.
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.