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Primary Care Blues

Cornelius Rubeus

Thursday, 28 February 2013


Noun: The provision of what is necessary for the health, welfare, maintenance, and protection of someone or something.

Verb: Feel concern or interest; attach importance to something.

The list of potential providers of care is ever-lengthening, with all and any willing qualified providers vying for business in primary care, secondary care and social care – the nouns are in place, but what about the verbs? How many of these providers actually care, in the sense of feeling concern or genuine interest in patients and their families – how many are more about balance sheets and share holder dividends – hitting targets and foundation status symbols?

For it to mean anything care has to be a ‘doing word’. The notion of care has been overtaken and blunted by a greater focus on targets and finances, with commercialisation and managers proliferating, whilst clinicians shrink into the background. Clinicians are probably more careful / less careless than they might have been in years gone by, do they also actually care less?

Their Royal College may reject the accusation, but many would agree that Nurses’ training has become so academic that students are ill-prepared for the realities of the job and they are less willing to carry out practical nursing care. There are ‘care-plans’ and ‘after-care plans’ but who is actually doing the caring?

Mid-Staffs was an example of a perfect storm with inadequate, target-obsessed managers, combined with unsupported, disengaged clinical staff and a joint failure to address the issues of poor care. The quality of nursing care came under intense scrutiny, with nurses seemingly unable to provide care that met patients’ physical and emotional needs. Staff, relatives and patients lived in an atmosphere where they were afraid to speak out about failures in care.

Unless a culture is created in which staff really are engaged, have realistic workloads and support, and feel free to raise concerns, there will inevitably be similar disasters in future.

The glue that holds the NHS together is its workforce, not just doing what is necessary for the health and welfare of patients, but looking outside their silo and being interested in the bigger picture – caring about the whole – even as it fragments around us.

Mike Farrar, the chief executive of the NHS Confederation, has called for a refocusing of what the health service is there for, saying the NHS of the future "will need to move from a medicinal service with a care dimension to a care service with a medicinal dimension".

In a world of people who couldn’t care less, be someone who couldn’t care more.

In the words of Nye Bevan: “The NHS will last as long as there are folks left with the faith to fight for it”

Author's Image

Cornelius Rubeus

Dr Rubeus is a hardworking, jobbing GP who trained in the North of England and now works in an inner city setting. He feels passionate about the changes affecting primary care and is not afraid to voice his views. He has his patient’s best interests at heart and wants General Practice to remain as the bedrock of the NHS for years to come.
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