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MiP London: Where now for general practice?

1 October 2010

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MiP Editor

Management in Practice London was always going to be a particularly exciting event, coming so soon after the publication of the Equity and Excellence health white paper. Over 500 delegates came to the Business Design Centre in Islington on 1 September to hear primary care’s key players discuss the implications of the coalition government’s reform plan, including senior representatives from the Department of Health and the Royal College of GPs (RCGP).

Dr Richard Vautrey, Deputy Chair of the BMA’s GPs’ Committee, kick-started the event with a keynote speech that asked the question that was no doubt on every delegate’s lips: “Where now for general practice?” Dr Vautrey outlined the key measures put forward in Equity and Excellence, including GP commissioning consortia, the NHS Outcomes Framework (a ripple of laughter among delegates at the government’s pledge to replace “targets” with “outcome goals” suggested many have difficulty distinguishing between the two) and the new single GP contract (replacing GMS/PMS) to be introduced over time.

He went on to argue that these hugely significant changes impart both risks and opportunities to general practice. “If the patient feels that you are making a referral or prescribing decision just to stay within your budget to actually make money, as the Daily Mail will suggest, then that has the potential to damage the doctor/patient relationship,” he said.

“Is this privatisation by the back door?” he asked, suggesting that “a lot of private organisations think the white paper is the greatest thing they’ve seen for many years”, owing to opportunities presented not only in the provision of healthcare but also now in commissioning in instances where GP consortia lack the resources to do this themselves.

Intriguingly, Dr Vautrey expressed concern that GPs could become the “fall guys” for efforts to reduce public spending on healthcare. “What is undoubtedly going to happen is that GPs will be blamed for the cuts that will have to happen. This is one of the reasons they are called ‘GP consortia’, as the intention is to devolve the blame. But conversely, if GPs do really well they could be accused of making excessive profits.”

But he concluded on a positive note, believing that the white paper was an opportunity for GPs to show what they could do, that it could lead to “real involvement in providing services for patients” and reduce bureaucracy – though he added: “But how long will that last before the Department of Health starts to ask more and more of consortia, as they did with PCTs?”

The afternoon’s keynote speech from Dr David Colin-Thomé, National Director of Primary Care at the Department of Health, was, by contrast, consistently upbeat. “General practice is the success of the NHS, and your jobs are the most fundamental part of the future,” he told delegates.

Dr Colin-Thomé presented the white paper reforms as an opportunity for general practice to extend its influence. “Up to now, primary care leadership has not been sufficiently appreciated.” He was adamant that general practice would rise to its commissioning challenge: “Our heritage is our localness and people knowing who we are. Population-based community is where the needs of individuals and of the community can be met.”

A plethora of leading primary care figures gave informative presentations on both practical day-to-day issues and upcoming regulatory requirements. Dr David Carson, Director of the Primary Care Foundation (PCF) and author of Raising Standards for Patients (also known as the Carson Report), presented key findings from the PCF’s report into managing urgent-care requests. Dr Carson gave measured advice to practices struggling to field phone calls from patients and supply enough appointment times – for instance, he said that often it is practices with difficult access throughout the day that face being inundated with calls first thing in the morning, further bottlenecking demand.

Dr David Haslam (Davids were in strong supply at this event), National Clinical Adviser at the Care Quality Commission (CQC), gave a reassuring talk on requirements for practices to register with the CQC by April 2012. He said he had three key messages: “Don’t panic; there’s plenty of time; and don’t panic.” Another key message was that most good practices will already be “doing the right things” assessors would be looking for and had no reason to worry. The CQC, he said, will be looking to ensure that “people can expect healthcare services to meet essential standards of quality, patient safety and respect their dignity and rights.”

The white paper emphasises that funding will follow the patient, who will have a greater choice of practice – any practice – by 2012. Marketing will therefore become increasingly important to practices, argued Dr Michael Taylor of the Family Doctor Association, who asked delegates a stark question: “Will you be a winner, or will you be a loser?” He said practice teams should focus on their shared values to offer optimal customer service, and suggested that surgery buildings should adopt conspicuous signage: “If people don’t know what you do when they walk by, you need to let them know,” he said.

As speaker sessions took place, many delegates also flocked to concurrent training sessions, which took place throughout the day and provided more indepth looks at topic including NHS pensions, managing commissioning responsibilities and data management. The vast exhibition hall featured a host of primary care providers who were available to talk about their products and services. Exhibitors included medicolegal advisers, IT specialists, practice accountants and medical associations. The kind support of these exhibitors ensures that these events are completely free to delegates.

The final word fell to another leading figure of general practice: Dr Clare Gerada, who in November will become the new Chair of the RCGP – the first female chair, she reminded delegates, for more than 50 years, receiving an enthusiastic round of applause from delegates. Currently Vice Chair, she gave an emphatic speech on the future of general practice.

The white paper was, she affirmed, “the biggest change to the health service since Nye Bevan introduced the NHS in 1948”. She urged delegates to engage with the “radical revolution”, arguing that general practice has not radically changed in 40 years with the result that it was “not fit for the future”; that future was bright, she concluded, “but it requires us
to look outwards and to work together”.