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Uncertain equity of clinical management

1 September 2010

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Consultant Editor, MiP

“We are optimistic, there is a new government and new opportunities.” For those of you who did not pore over the newspapers (whether medical or the more conventional type) over the summer months or have their eyes glued to the TV screens, these words are attributed to Dr Laurence Buckman, chairman of the British Medical Association’s GPs’ Committee.

Dr Buckman’s comment relates to the new government’s proposals in their white paper Equity and Excellence: Liberating the NHS. He adds: “But we are reserving judgement. We felt optimistic in 1997 and that did not work out as we would have wished.” He doesn’t sound entirely convinced, does he? In reality, how many of us are?

I have to admit that I’m rather sceptical about the introduction of GP commissioning consortia. Not because it scares me or because I dislike change (after all, change is what keeps people like you and me in a job), but because I think someone perhaps needs to step back and say, “Ok, this might be a great idea, but we really do need to take a reality check here. Don’t we have enough to do? Aren’t we good at what we do? Isn’t that enough?”

The answer to those questions is yes, we are good at what we do, but because we have pretty much excelled at meeting every standard set for us, we need to do more – but at what cost?

It almost feels as though primary care is being punished for the last government’s mess up with the Quality and Outcomes Framework and the new contract. GPs have been a constant news item since 2004, with headlines mainly relating to pay. Now it seems that we are required to justify our existence further by spreading ourselves more thinly. That is the only way that the GP commissioning objective will be met: more management by clinicians.

I agree that clinicians know what is best for their patients, but unless they get good support mechanisms from managers, how will they fit everything in? Furthermore, how will that support mechanism change from the one that we already have? Primary care trusts may go, but they will arguably morph into something else.

The NHS has fed its middle managers well and it could be argued that they have bled the system dry, but without them who does the work? Do we want GPs to become administrators? Surely not. And NHS middle managers are not going to go without a fight.

I’m sorry if I sound cynical. I really do hope that Mr Lansley’s proposals work and that we lose some of the fat cats (forgive me but there are some) and save the NHS money that could be spent more appropriately. But at what cost? More burnt out GPs retiring early? We are then left with fewer partners and an abundance of salaried GPs.

Our practice is now split 50/50 between salaried GPs and partners. The majority of the former are salaried GPs for a reason: they want to do the job they trained for, ie, treat patients. How do we incentivise them to get involved in GP commissioning? We can’t offer them more money, as there isn’t any. So I am reserving judgement. I am not currently optimistic, but I do so want to be.

All that said, it should be remembered that we are still at the consultation stage. Anyone would think that the deal was already done, so in the meantime we must get on with the day job.

To help support that, Management in Practice Events continue. We’ve just had a very informative conference in London, with excellent speakers, and there is still time to sign up for MiP Birmingham on 20 October at the NEC, where Dr Laurence Buckman is due to give the closing speech.

Management in Practice Awards are traditionally presented at Birmingham, which is our final conference of the year. The awards presentation provides a spotlight to some excellent achievements in general practice, so even if you haven’t entered attending is a great way to show your support. I look forward to seeing you there.