SUPPORT YOUR SURGERY

BY Dr Paul Charlson GP in Brough, East Yorkshire

Board member www.2020health.org

 

“Support your surgery” says the BMA campaign aimed at the public to raise the awareness of the threat of polyclinics to local GP services. It is a simple message and one that is likely to resonate with generally satisfied patients.

 

In its haste to protect traditional General Practice the profession must be careful it does not appear to be negative and self serving. A simple message is fine for a media campaign but the situation is far more complicated and requires balanced argument.

 

Large GP centres open longer hours providing additional services are a great idea in places where they are needed. They are not needed everywhere so why is the Government effectively forcing every PCT to have at least one?

 

Setting up a centre in competition with local GPs in areas with high quality practices as proposed in East Yorkshire seems illogical. The cost of building a new centre will be high and running costs are likely to be higher than estimated. Even if there is £250 million of “new money” for access this is not enough to provide for the proposed 263 new centres. It seems likely that PCT budgets are going to be stretched further and this will continue for years to come. Surely it would be more cost effective to provide money to existing surgeries to develop a more expansive service.

 

Another major concern is the APMS method that has been used to procure these new services. APMS bids are complicated and the work involved daunting. This penalises existing practices that often do not have the time or skills to develop a successful bid. It therefore encourages competition from commercial organisations that may be answerable to share holders and are all focused on the bottom line. The Government response to this is to enforce rules to ensure quality. Anybody working in healthcare knows that rules are not necessarily effective. General Practice is not perfect and there are probably a few rotten GPs about but in the main we all joined the profession to do a good job and run our practices to provide a good service. Of course we are there to make a profit but in my experience most get the balance right. I am not convinced this will happen with commercial providers who may circumvent the rules in pursuit of profit.

 

The timeframes for the procurement process are also very short and previous experiences show that setting up a contract for primary care services can take a year and building new centres will take even longer. The timescale for APMS contracts is bound to cause some serious mistakes affecting patients and wasting valuable resources.

 

 

The National Primary Care Research and Development Centre found that patients would pay three times as much to see a doctor that they know than to have an appointment a day earlier. They value continuity over access. Commercial organisations tend to think along a locum or salaried type model which is less likely to provide continuity of care. The net result will be that where these centres are set up in competition with local practices they might not have many patients to see and end up as an expensive white elephant. Furthermore, there is evidence that established GPs who know their patients are less likely to refer or order inappropriate tests therefore reducing NHS costs and providing more focused patient care.

 

 

I can understand why the Government might become frustrated and impatient with GPs. Some of my colleagues by either putting their heads in the sand or being resistant to change have not helped the cause. However most GPs are keen to make their practices better but have been discouraged by an innovation blight for the last few years. A prime example of this is Practice based commissioning which promised so much but so far has delivered so little.

 

Some inner city areas suffer from what might be perceived as poorer quality practices as judged by QoF and there maybe some truth in this. Generally inner city GPs including single handed ones do an excellent job in difficult circumstances. It seems the Government blames GPs for higher obesity, smoking and drinking rates in these areas together with the morbidity that goes with it. We all know that it is more do with the patients lack of motivation to change their lifestyle. This of course is far more difficult to tackle and the measures needed might not gain votes.

 

The Government has also resorted to underhand methods to justify change. For instance the professional discussions on the “Next stage review” have been largely a sham. More alert colleagues involved with this report have reported the it was clear what the outcomes would be before the discussion took place. I know this statement is anecdotal but I am sure it could be justified if research was carried out. In Hull the questionnaire sent to patients was designed to get yes answers to proposed polyclinic. For example, Are you in favour of a new building open 12 hours a day? Well yes. It does not mention that it might be further away and that their nice old local GP down the road might be forced to retire as a consequence, this might change the answer given.

 

I do not think that GPs are against either change or the polyclinic idea and generally welcome the opportunity to develop their practices. I am disappointed that the Government has used the “one size fits all” prescriptive sledge hammer approach. I am convinced just as with out of hours they will live to regret introducing these changes and in the process alienated the profession. The whole exercise wastes energy that would have been better channeled into other things.