"Should you find yourself in a chronically leaking boat, energy devoted to changing vessels is likely to be more productive than energy devoted to patching leaks.” Warren Buffett, Berkshire Hathaway, CEO
Don’t you just love the way politicians scapegoat anyone and everyone? Except themselves of course: no self-blame is ever given for the mess they themselves create.
So now we know: General Practice is the cause of the crisis in the NHS. It’s absolutely nothing to do with chronic underfunding, rotten political policy, inability of Clinical Commissioning Groups to actually commission services, and make the move from into, to out of hospital care and properly fund it, or the reluctance of hospital providers to actually let the work and resources go. Instead, we have patch after patch on the leaking boat. Only now the boat is in real danger of sinking, so let’s blame General Practice for not being open 08.00 to 20.00 seven days a week. Except it is: it’s called Out of Hours between 20.00 and 08.00.
The same hospital consultants now asking General Practice to take on more workload are the very people who have turned down approaches that have been made throughout the last four years of my working with General Practice at scale, to shift work out of hospital and free their time and resources to focus on the patients who do need their level of skill and input.
The same CCGs now asking General Practice to open longer, invariably with no additional payment to do that, are the same CCGs who have turned down every single proposal to move work from into, to out of hospital care for 50%, 60%, 70% of PbR tariff, which of course means savings to the commissioning budget that could be reinvested. I have hundreds of proposals in that vein; every single one of them rejected by the hospitals and/or CCGs, and yet somehow now it’s General Practice that are to blame for the crisis, and not those who steadfastly and without any accountability refuse to engage in transforming the delivery of care.
Why are these proposals for General Practice to undertake additional work so important? Why do we want to take on more if we are snowed under? And why in those circumstances do I always have a willing queue of Practices willing to take the work on?
Put simply, it’s about proper resourcing and funding, instead of expecting work to be done for free, which is now at levels that are no longer safe or sustainable. The income these services generate goes towards keeping practices open and the staff paid, many of whom work part time and would increase their hours if the money was there to pay for it. This is not about “fat cat GPs”, it’s about sustainability, it’s about keeping General Practice open and able to see the patients currently engulfing the system.
For the numbers currently sitting in A&E, I say to the hospitals, welcome to the world of General Practice, this is what it’s like every day, only that doesn’t make the news headlines. Nobody is interested. It appears nobody in CCGs, NHS England, the Department of Health or Government care at all – General Practice can sink and they don’t care. In fact, they think it’s productive to slate GPs in the press, disincentivise working in General Practice by making the job impossible, and then wonder why nobody wants to be a GP. Completely counter-productive, complete own-goal. This is why we have Practices handing their contracts back, why General Practice is struggling to recruit and retain staff and still nothing is done to try and stem the tide – instead General Practice is to blame for the entire crisis. The entire system focus is all on Secondary Care and then we wonder why the money flows in that direction?
The reality is that if CCGs and NHSE didn’t open on Monday nobody would notice. However, if two or three General Practices in the same area decided to have a day off, or work from home, the system would collapse and yet that same system refuses to engage in working with General Practice to ensure it is properly funded, properly resourced to deliver the work it can and should deliver, and above all else it remains sustainable not just for winter 2017 but for years to come.
The choice for the system leaders is simple. Continue to do what you have always done and you can expect the same outcomes. Einstein defined this an insanity.
Or alternatively, stop patching the leaks in the boat and instead look at how to quickly and safely transform care. Move appropriate work from secondary care out in to General Practice, only ensure it is properly resourced and that clinical pathways are sensible. The myriad of services that could be delivered by General Practice, operating at scale to ensure one high quality and standardised approach, would relieve the pressure and provide the breathing space required to go on and be even more ambitious in the move of services out of hospital and into the community. To achieve that Simon Stevens needs to hold CCGs to account, measuring the services shifted and transformed on a month by month basis.
This is not about structures. It doesn’t require another reorganisation. It will only be met through changing clinical practice; truly transformational, with a clear clinical focus and added clinical value.
The question now – is anyone listening, or will the boat sink?
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