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by Steve Williams
29 June 2009

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A call to arms as the reforms roll on

Primary care policy is dictated to practice managers without consultation, says independent healthcare consultant Steve Williams (pictured), who says it’s time for this to stop and for the profession to receive due recognition …

A battle that we are continuing to fight, or simply a pointless crusade to which no one subscribes? I am referring to the start of yet another financial year in which we see primary care management thrust into the spotlight.

It appears that change is on the horizon: yet to be clarified, yet to be defined, but nonetheless imminent. Who will be the beneficiaries of such reform? One thing is certain: it will place increasing pressures on already strained professional practice staff who give everything as a reactive body, but who very rarely get heard.

Who seeks our professional opinion when deciding how to deliver local services to local populations? In order to become world class, we need to win the local league first, and I think that reflects why such top-down driven policy becomes ineffective.

Practice managers and their staff will commit everything to making change work, but what is the point of discussing strategic commissioning objectives when you still have not confirmed what last year’s performance actually was?

We will be facing uncertain times in the future with regard to public spending on health and this will have a direct impact on services provided in primary care. Why are we pushing forward with GP-led health centres when local opinion has stated that they are unnecessary? Is the concept of turning existing practices into extended urgent care centres the right way forward?

At the moment, there is a culture of “if I do not do it, then someone else will”, and that could be a threat to the practice.

General practice has coped and struggled for years with the concept of practice partnerships. Many are successful; some are not. Co-operatives, federations, limited liability partnerships, limited companies and shareholders are examples of more spin relating to the concept of working partnerships. Yet most of these have arisen due to policy implementation.

Are single-handed practices now being eroded? Why have we seen an increase in the number of remedial notices being served on practices? Why are local GPs being beaten in the tender process by third-party organisations?

“Governance” is increasingly becoming the buzzword as more and more PCTs push for monitoring and control on a range of practice-based issues. In truth, they are using many of these targets in order to meet their own performance targets. Not necessarily a bad thing, but did anyone consider the implications for those working in the practice? Much of this is done above and beyond the contractual responsibilities.

When the country was almost brought to a standstill because of the unprecedented snow and ice earlier in the year, local decisions had to be made about healthcare provision and the level of service that resulting skeleton staff could provide. All of this had to be done considering the safety and welfare of both staff and patients.

Interestingly, no one was available at the local PCT due to the inability to get to work because of the severe weather conditions. However, a service, albeit reduced, was maintained and I applaud all of my staff and colleagues who made it happen.

Earlier this year, when faced with a Quality and Outcomes Framework (QOF) visit, I found myself defending a practice told that they would not qualify for any points, because they had not recorded any complaints that year.

The lay assessor was full of praise at the way the practice staff dealt with patients, and could clearly see that this was a group of dedicated individuals. However, the computer says “NO!”

Do you maintain high standards or do you play the game? I would hope that the majority would prefer to be able to deal with practice complaints efficiently and effectively, but perhaps those that define policy should ask us what we think? At this time of political unrest, cabinet reshuffles and shadow minister statements, would someone like to consider asking us what our considered opinion might be?

We have now heard of the consultation process that has started with regard to the future accreditation of general practice. The King’s Fund has been tasked to do this, and I do not think there is a manager out there who does not realise the implications of the need to register with the Care Quality Commission.

Many of us already aspire to high standards in relation to patient quality and safety, and therefore this should not be a problem. However, it will not be managers that deliberate the changes: it will be the usual arms-length bodies, which may not convey some of the depth of feeling that our profession truly represents.

We need to demonstrate that we can show high levels of competency and also show that we play an active part in maintaining our own continuing professional development standards. Currently, there is no statutory requirement for this, but I know that for many it is a standard we readily embrace and implement at all times.

Through my professional connections and contacts, I will continue to advocate the increased profile and recognition of the modern professional practice manager. This also includes support staff, without whom the very fabric of the family-doctor service would be completely eroded.

It is time for those that dictate policy to recognise the true value of practice management: both in financial worth and professional opinion.

I for one recognise that I am embarking on a worthwhile crusade, during which various battles will be encountered. I know from discussions that I am not necessarily alone, but now is the time to let others know that we do have a worthwhile opinion, that we should be valued and that we are a significant part of the fabric of modern primary care.