The Chief Exec of NHS Providers (that's hospitals to you and me) has at last made visible to the public and the media what we all have known and been saying for months, if not longer. He says that the NHS is close to breaking point because of its escalating cash crisis. And that years of underfunding have left the service facing such "impossible" demands that without urgent extra investment in November's Autumn Statement it will have to cut staff, bring in charges or introduce "draconian rationing" of treatment. All options that will provoke public disquiet, it says, and which we know apply as much to ourselves in general practice as it does to secondary care. It is against this backdrop that we must see the current round of NHS change or 'transformation' which includes:
- The NHS England FYFV (Five Year Forward View - Oct 2014 so we're now two years into the 5) - 'new models of care' and "voluntary" contracts and such like. Also promised 'stabilisation of general practice within two years' - 'nuff said.
- The NHS England GPFV (GP Forward View - April 2016) - the inadequate so-called 'rescue-package' for general practice will mean a small per patient increase and only if - and it's a big if - we can get Harry Potter to summon up the Alohomora charm and then elicit the Heineken effect to get the cash to where it needs to reach.
- And now, STPs (Sustainability and Transformation Plans - the clue is in the title) which for the last few weeks have been referred to by NHSE as "footprints" of which there are five being created across the old Strategic Health Authority areas or 'sectors' of London . Remember those? (More below on STPs.)
As if we GPs and our teams haven't had enough to contend with, we now are blessed with another new wave of planning, this time putting the inadequately resourced buckets of health and care together; spreading them over seven days instead of five, and expecting those of us at the frontline - well before any non-emergency patient should even need to get near a hospital - to somehow absorb all the load, the demand, and risk as if we created this problem. Well it's time to say loudly and clearly; we didn't!
- It's not GPs who have been saying the best way to run a health service is to allocate only 8% of the budget to general practice (or nearer 7%, depending on who you trust!).
- It's not GPs who have been saying strip out our health visitors, put district nurses on a caseload treadmill so stretched that they too cannot be retained. Ditto social, mental health and other community workers and stretching voluntary and charitable services beyond their capacity.
- It's not GPs who have been disinvestesting in our workforce, premises and the services (community, mental and social) general practice needs around us: to do our jobs effectively; to direct patient care to where they need to access it; and not to pander to pathways where the money flows under the discredited payment by results system (ie. keeping patients away from hospitals they wouldn't need to attend if those services around us were properly and adequately financed.)
- GPs have not created this mess. And nor have patients.
There. Said it. So now what?
I still believe general practice has the key - even though we have had the stuffing taken out of us. Perhaps it's drawn from personal resilience.
Either way, I'm not prepared to let the powers that be destroy what I believe in and what I remain pretty convinced you believe in too - the values that we as GPs and our teams hold dear:
- Neighbourhood based expert generalists
- Dealing compassionately with patients
- Providing person-centred care by relating to patients as individuals
- Using problem solving to help patients through uncertainty and marginalise danger without medicalising normality
- A collaborative approach to manage co-morbidity and coordinating complex care
- Understanding and utilising the physical environment of practice populations and the interrelationships between health and social care
- A holistic approach by understanding and respecting patients' values, cultures and family beliefs, and how these will affect the experience and management of illness and health
As GPs we and the teams we work with have to survive this current chaos with even more determination than all the other waves of chaos. So if transform we must, then let us not do it at the expense of our values, compassion for patients, or compassion for ourselves. Let it be a transformation in our own image and not the image of those who still just don't get it.
We're making sure that the powers that be in London know what that image is by:
- Making the case to MPs for more LMC involvement, using stats on STPs from our workforce survey (all in this letter), and we've already received positive responses, including this one from Tom Brake MP. Both Tom Brake and Theresa Villiers MP told me they will raise our concerns with the Health Secretary.
- Working with the Mayor to help shape his Health Inequality Strategy for London - due to be launched next year.
And with that let me take you back to those STPs. Well surprise! Here's my prediction: each STP along with their constituent CCGs, will very shortly be operating as one entity, returning us to five planning bodies for London, albeit this time with closer alignment to local authorities. Who knew?! So as an starter for ten, take a look my STP Q&A and I hope you agree that Local Medical Committees and general practice still have a fight ahead of us in this brave new world of transformation, devolution, sustainability and survival.
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