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1st October 20
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Dr Costa  
News and Comment from Roy Lilley
 

We know there's been something wrong in GP-land for long enough. It is a curious mixture of conflicting facts, competing priorities, events and happen-stance.

 

GPs provide over ninety percent of first patient contacts for less than nine percent of the budget. It used to be eleven. And, they are seeing more people than ever before... no one seems to know why.

 

We know that opening hours are often out of sync with commuters and the working population. We know there are not enough GPs and curiously and contradictorily, some are earning over �100k whilst other practices are going broke.

 

Doctor's leaders seem stumped for an answer. The politicians have lost patience and what better opportunity than the Tory Conference in Brum to go for a populist, easy kick at the GPs open goal.  

 

The NHS is the last thing politicians really want to meddle with and the last thing they can ignore. This time GP's procrastination has made it easy.  

 

Easier, quicker access to a GP, who knows who you are; simple. If the Tories are re-elected, by 2020 something like �400m is on offer for longer opening hours, better access and the long overdue adoption of telecare techniques. That might mean around �50k per practice.  

 

Now, before the GPs and practice managers reading this crank up their Amstrads and fire off the usual green-ink-invective I know you will tell me it's a spit in the bucket and nowhere near enough and blah, blah. And you are right; it would be good if we could discover the trick to five day opening before we launched into seven. And, yes I know there is an ongoing pilot doing extended opening that has had a slow uptake and no evaluation.

 

You're missing the point. And, I believe, so was a gullible Conservative audience in Birmingham's Conference Centre. There is no way that amount of money will be enough to ensure you get to see 'your GP'.   It might mean you get to see 'a' GP at 'your' practice but I doubt even that. It is much more likely that you will get to see 'a' GP somewhere.  

 

Somewhere might mean A&E; whether they can access your medical records is a whole issue that no one seems to have thought of.

 

Not wishing to carp, or sound grudging but it is not even enough money to make sure you speak to 'your' GP on the phone or Skype or Face time. It probably is enough money for you speak to someone in a call centre.

 

This is money that used in the usual way will not change access to primary care. This is money, used in a smart way that will change primary care.

 

Give �50k to a practice, tell them to open all hours and get some telecare sorted will simply mean patchy access and locum cost inflation.   Giving three or four practices �50k each and let them club together and �200k becomes serious and you can start to do things.  

 

Syndicate the money, federate the practices and before you know it practices will cut back-office costs, practice managers, running and procurement expenses.

 

Divvy up the money between a whole CCG and then you can start a revolution. The whole landscape of primary care is set to change.

 

Family practice is supposed to be just that... doctors looking after your family. The Tories know that and as much as they would like to turn the clock back to Dr Finlay they know they have to ratchet forward to Dr McCoy.

 

Healthcare across the desk disappearing. Healthcare across the internet will be the new intimate. A named GP only in token; a case manager, a broker, a friend in the business.

 

General Custer was undone by too many Indians. General Practice has too many patients. This money-4-access (by the way will it be new, within the Departmental Expenditure Limits, or Annually Managed Expenditure or the contingency reserve, or the tooth fairy) is a fulcrum point, a lever for change, a tow-rope to pull primary care out of a hole and give it a kick-start.

 

The future; specialist nurses will lead on long-term conditions.  Patients, who are able, will talk to their friend and case manager in a call-centre and GPs will be running coffee mornings for the patients they really need to see.  

 

Dr Costa, now there's a thought.

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