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by Stuart Gidden
3 September 2009

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MiP London: is general practice in danger of losing its personal touch?


Supervising Editor
Management in Practice

The MiP London Event (2 September 2009) raised so many issues for discussion, it’s hard to know where to start. It was great to see so many of you at Islington’s Business Design Centre (pictured) – this was the third consecutive year that we have held an MiP Event here, and each year light is shed on a new demand for practice management.

This time, the key issue that seemed to cause alarm for many was the upcoming Care Quality Commission (CQC) regulation of all healthcare providers – including general practice – from April 2012 (October 2010 for private GP practices), which will mean practices will need to demonstrate compliance with quality standards.

Dr Linda Hutchinson, Director of Registration at the CQC, gave the keynote address yesterday, and there was a sense of a collective jolt to the several hundred delegates attending as the new requirements, which were no doubt already known to many, became starkly apparent.

The issue provides much scope for discussion – is general practice in danger of being over-regulated? Or is the reverse the case – that more regulation is required? A show of hands during GP and comedian Dr Phil Hammond’s humorous afternoon session indicated that many managers adopt the latter view.

When asked if they were confident of adhering to Dr Hammond’s “Paxman test” – ie, could you submit to a grilling by the BBC’s Newsnight anchor Jeremy Paxman and be confident that you could argue that your practice was offering high-quality and effective patient services – there weren’t all that many managers who raised their hands. Perhaps the CQC regulatory requirements are to be welcomed if they are to expose a minority of practices that aren’t up to scratch?

However, comments from one delegate during Dr Hutchinson’s presentation were echoed later by Dr Hammond – that practice nurses are already spending so much time form-filling and ticking boxes that they are no longer able to spend vital face-to-face discussion time with their patients. Is the danger of regulation (or over-regulation)?

I suppose there’s an ideal balance to be struck – that general practice can be subjected to rigorous quality appraisal without losing the informal relationship with patients and the continuity of care that we know patients want from their practice. Perhaps the CQC, who have recently concluded a consultation on their approach, will achieve this? We shall see …

With three concurrent streams of informative presentations, there was much I would have liked to have seen but could not. In particular, Jill Fletcher, Director of Medical Services at finance experts PKF, gave a hugely popular and packed-out presentation on planning income through recessionary times, and likewise I heard positive delegate responses to both Dave Roberts’ session on information handling in primary care and Dr Nick Goodwin’s discussion on the future of practice-based commissioning.

I attended an excellent morning presentation from solicitor Derek Bellew on legal issues in general practice. Derek gave valuable advice on several key areas, from practice mergers (“merge in haste and repent at leisure”) to managing new GP partners (use the probationary period effectively, as any problems will be much more difficult to deal with later) and partnership agreements (establish effective partnership appraisals – these will be even more necessary once CQC regulation comes into play, was Derek’s advice).

The Event also facilitated an announcement of the new NHS Practice Management Network, which included asking delegates on key issues they would like to see discussed in this new professional support body for England, launched “for the profession, from the profession”. Delegates told practice managers Sandy Gower and Geraldine Taggart-Jeewa, and Dr Mike Warburton, the National Director for GP Access at the Department of Health, who were all associated with the new network, that an end to “GP-bashing” and (again) clarification over CQC regulation were two prominent issues to be addressed.

Dr Phil Hammond proved the perfect speaker to kickstart the afternoon, with his consideration of GP regulation not only shot through with his customary wit, but also a passionate defence of the key values of general practice – the personal relationship with patients and individual practitioners, which is too varied and human to replicate from one practice to another.

The Question Time-style afternoon panel session, which has become a key facet of the MiP Events, was ably chaired by independent practice management consultant Steve Williams and allowed delegates a chance to comment on topical issues for consideration by the expert panel of Dr Brian Dunn, chairman of the Northern Ireland GP’s Committee, Penny Emerit, Polyclinics Project Manager at Healthcare for London, and leading practice manager and Fellow of the RCGP Sandy Gower.

Penny gave a robust defence to some delegates’ belief that polyclinics could threaten the GP-patient relationship, asserting that their introduction was about more than merely new buildings but would maintain patients’ relationship with one GP while “improving the quality of patients’ experience”. Dr Dunn however maintained that access was the one area of general practice that the government cared about, to the detriment of the personal side of which Dr Hammond had talked of.

The same session also discussed practice funding, the government’s handling of the swine flu threat, the encroachment of private providers – a manager from Camden was passionately opposed to the fact that, as she told assembled delegates, the PCT in that area had awarded all contracts to such providers. It’s evident that primary care, for all sorts of professional and political reasons, is undergoing a transformation that will divide and sharply affect practice managers.

I hope that these MiP Events, as with the London conference, will continue to give a platform that enables managers to learn of new developments and to voice any concerns for the benefit of their profession – and, of course, their patients.