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New Year NHS resolutions

Hard-wired GP

Luke Koupparis

Wednesday, 02 January 2019

AdobeStock_219250873_NY_BLOG.jpgThe new year is upon us. Like most people I have considered my new year’s resolutions carefully, hoping that I might be able to stick to them until, at least, the end of the month. Cutting down on sugar will be difficult due to the mountain of Christmas cake that remains half eaten in the kitchen. Perhaps weaning off slowly is a much better idea which might achieve success.

Predictions and resolutions for the NHS in 2019 might be a little more challenging. We have not yet had sight of the eagerly awaited NHS long-term plan. Remember, this was the plan around what to do with the extra £20 billion announced by Mrs May last summer. However, the political paralysis caused by Brexit has prevented it from being fully reviewed by relevant ministers, most notably the chancellor, hence the delayed release.

So what sort of resolutions would primary care ideally want from this new plan? Ahead of the official publication, I thought it would be prudent to come up with some wishes and warnings. So here goes with my list…

1. Workforce investment: remember the 5,000 extra GPs we were promised by 2020. When comparing full time equivalent numbers to 2015 there are 906 fewer GPs. So, this is definitely an area that needs significant priority. However, increasing numbers depends on a number of factors so maybe addressing them in the plan would be helpful.

2. Demand management: demand keeps rising and more work is being transferred out of hospital into the community (without additional investment). We are told there is no magic money tree and the NHS has run out of money. Moving work out of hospitals into a primary care system that is under strain just isn’t going to work. The NHS is broke but GPs should not be the profession who take the flack for telling patients. New investment must to go into primary care to help it meet this increasing demand.

3. Longer appointments: if GPs are to deal with more complex patients with the self-limiting conditions being routed to allied health care professionals, then we need more time. We cannot squeeze a shopping list of complaints into a 10-minute slot. 15 minutes should be the new standard, longer for more complex patients.

4. Indemnity: it is important to get this right and it impacts on point 1. Rising indemnity is just forcing GPs out of working as they just cannot afford the spiralling costs. I have spoken about the state backed indemnity previously - it shouldn’t merely be a fudge to fund this by an underhand drop in global sum payments.

5. Bigger is not better: accept that forcing us into megalithic GP federations is not the answer to sorting out the problem of primary care. I have written about this in past blogs. The key to success here is preserving what is good about General Practice and not about changing things because it is the latest and greatest big idea to come from on high.

6. Remove needless box ticking: there seems to be a continuous push to increase the bureaucracy for practices. I don’t disagree with having standards, but for those practices or practitioners who exceed the required level, then reducing frequency of further visits would help them do the day job and not merely having to chase targets by ticking needless boxes.

7. Skype consultations have a limited role: video consultations may be seen as the latest innovation to solve the issue in point 2 above, but they are only going to serve to destabilise practices further and only serve a population with little wrong with them. Patients with serious chronic illnesses need to have continuity and a financially stable practice offering the full range of services. Disrupting practices by allowing Skype only services to flourish is not the answer. 

8. Improved access: due to the factors listed in point 1, there are very few GPs left to deliver these improved access appointments. Spreading existing resources more thinly to deliver political soundbites will not achieve the target of increasing routine appointments at evenings and weekends. It will merely shift daytime work into other times of the day. Invest in providing a robust in hours service which can meet demand and invest in out-of-hours services.

Many resolutions fall by the wayside as one moves further away from the new year. Let’s hope that the items in the new long-term NHS plan do not follow a similar course. On that note, I am off to tackle the last remnants of that Christmas cake. I can always cut down later in the year if really needed.

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Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group, LMC representative and chair of the locality provider group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist and likes to ski with his children.
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