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Things to look forward to

Still practising

Chris Preece

Monday, 25 April 2016

future medicine_shutterstock_407449360_v2.jpgA number of news outlets have reported on the new General Practice Forward View, with many of them describing it as a “rescue package” for Primary Care. I confess, having read it, “rescue package” seems a little generous. Imagine for a moment that you’re drowning - suddenly you see someone at the waterside. However, instead of pulling you out, they set up a series of focus groups, and give a Powerpoint Presentation entitled “Why Drowning Is Bad”. I suppose it’s nice that they’ve noticed you’re in trouble at last, but it would be better still if they’d just throw you a lifebelt.

Others have described the document as a look into the future of Primary Care. So, as part of OnMedica’s ongoing dedication to bringing you the latest medical news before anyone else, I’m not going to be writing a pithy summary of the existing GP Forward View. Instead our resident army of technological geniuses managed to open a wormhole to the year 2025, to offer us a literal look into the future. Here then is a future DH document, oddly familiar in structure and tone, to give us an insight into how much will change, and what to expect in the years to come. Here it is:

Future Vision for General Practice 2025

General Practice arguably represents the most important job in the Democratic Independent Republic of England. If someone had said 10 years ago, “Here’s what the NHS should do now – make a series of largely non-committal promises which we can then workshop for a decade”, they would have been laughed out of court. But looking back, that’s exactly what’s happened. Still, we’ve really learned this time – so it’s with great pride that I can now present our plans to really transform General Practice over the next 10 years.

Dr Julius Hibbert

Chief Executive NHS™ England 2025

Part 1: Investment

We will invest a further £4 billion a year into Primary Care by 2030. As the overall NHS budget will continue to be subject to the Government’s new “Super-Austerity” initiative, this does mean that we will be cutting funding elsewhere within the healthcare system – but we can see absolutely no way that this could negatively affect Primary Care. It is estimated that, after this funding has been allocated to the various re-training initiatives, management re-structures, and essential building works, the amount that actually filters down to individual practices will reach a new high of approximately 2.4%. 

In addition a new funding formula is being scribbled on the back of an envelope at this very moment, and we’ll let you know the day before it’s implemented whether or not it will bankrupt you.

We recognise that, since GPs are now obliged to work within NHS Community MegaHubs™ seeing patients who may not benefit from the continuity they previously enjoyed, the cost of medical indemnity has risen significantly. We hereby confirm that we will commit completely to whatever solution emerges from our indefinitely ongoing discussions with defence organisations and insurers.

Finally, General Practitioners will be delighted to hear that the “Even Better Care Fund” has now been expanded to include all NHS™ and Local Authority Budgets. Whilst it is true that Local Authority budgets have been essentially slashed to zero in the last few years, we’re delighted to say that by lumping it in together with the health budget we can claim to have increased it. 

Part 2: Workforce

We are aware that many practices continue to struggle with recruitment issues despite an exhaustive poster campaign. To this end we will be increasing the number of doctors in General Practice by 10,000 by 2030. We have a 10 point plan to deliver this, namely:

  • Counting anyone who has expressed an interest in medicine to their school careers advisor.
  • Establishing a “Back to Work” scheme for GPs who have had children, including basic training so that the baby can work as a Physicians Assistant.
  • Offering substantial cash bribes to anyone prepared to work in the Government recognised “Hell Zones” – this would appear to be much cheaper than actually addressing the underlying problems.
  • Counting any doctor who visits their GP as “a doctor in General Practice”.
  • Making the provision of a pension dependent upon having completed a minimum of 65 years of work (full time equivalent).
  • Forcing all junior doctors to work in General Practice for at least 10 years as part of their foundation training.
  • Removing the requirement for formal medical training for practitioners within “Health Academies”
  • Kidnapping doctors from developing countries.
  • Form a working group to establish how we might resurrect dead GPs and bind them to our will.
  • Lots more posters.

In addition we’ve decided to recruit lots of other people that the NHS™ is short of from their regular jobs, and make them work in Primary Care - although we’re not exactly sure what precisely we’re hoping they can do.

Part 3: Workload

GP workload continues to increase by about 3% each year, despite previous attempts to address it.  We have thus developed a number of initiatives to help reduce this. Firstly it has been identified that some patients attend General Practice when they perhaps do not need to. In order to address this we have commissioned a number of VR Advertisements starring celebrities under the banner title “Are U sure U R sick?!” These adverts will run during primetime slots, after shows such as “This Person Had Something Unspeakably Rare – Maybe You Do Too”, “When Sore Throats Kill” and “Drunk Doctors”. (This will be funded by making a cut in the health promotion budget for schools.)

Further to this initiative we will be threatening hospital colleagues with the lash should they fail to quickly convey information to Primary Care via instant digital Holo-Form. (A single IT solution for the NHS that would allow instant access to records for all clinicians is, of course, utterly impossible.  Because.)

Finally inspectors from the Quality Inquisition retain the right to investigate practices whenever they feel like it. However, just to make you feel better, we’ll say that those of you who are excellent will have a maximum interval of 7 years between visits – and then hope you don’t think too hard about what “maximum” means.

Part 4: Care redesign

Many practices are already part of a NHS MegaHub™ whilst others will still be considering their options. To help practices decided on their future, we’ve developed some simple Q&As:

Q: Will every practice have to be open at weekends and evenings?

A: No. This is not about every GP or practice being available at all times of day. However we’ll continue to make it sound that way in political manifestos. You don’t have to work every hour God sends you – however we reserve the right to brand you as lazy, and lacking vocation if you don’t.

Q: Who decides what the service will look like?

A: This will be entirely up to local commissioners, who will have complete flexibility to design services as they wish. It is reasonable to note however that in order to access any of the funding set aside for Primary Care it will have to fulfil the requirements of the National MegaHub Specification, and commissioners will have to submit three monthly reports detailing precisely how much money has been saved. (The Specification is liable to change at short notice, and funding provision may be withdrawn without warning. Usually after you’ve hired staff.)

Q: What does this do to my existing workload?

Increasing the number of days and hours that you work is absolutely guaranteed to reduce your workload. We are confident that there is absolutely no unmet need or demand within the system, and really, you’ll be twiddling your thumbs all day.

Q: What are the benefits to practices of working at scale i.e. through federations or merger?

Simple. It is no longer financially viable to do anything else.

Conclusion

We understand how much pressure General Practice is under, and we want to reassure you that everything is going to be absolutely fine. Really. After all - reassurance is cheaper than actually doing anything.

P.S. On a completely unrelated subject, we’ve agreed to substantially increase the budget for Mental Health support for doctors.

Author's Image

Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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