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Rapid Responses: Rapid Responses published:
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Failing to reassure doctors: pushing ahead without consultation
- Lindy Williams (16 May 2008)
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Re: Failing to reassure doctors: pushing ahead without consultation
- David A Fitzmaurice (16 May 2008)
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Sharing innovation in primary care globally
- Claire L Jackson (17 May 2008)
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Pledges ignored
- Anne Holmes (11 June 2008)
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Lindy Williams, Independent writer BD23 4QH
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The RCGP is certainly right to be worried about PCTs pushing change without consultation with GPs over what may or may not be needed. On 25th April, Healthcare Republic website reported that the Department of Health had, in one if its most appalling insults yet to general practice, made a presentation to PCTs telling them not to consult GPs when planning for new polyclinics. (http://www.healthcarerepublic.com/news/GP/LatestNews/804953/DoH-urges- PCTs-ignore-GPs-polyclinics/ ) Furthermore, even if there were public consultation - and PCTs do have an obligation to consult before initiating major changes - it would most likely be undertaken by a private specialist consultancy firm whose aim is to provide the 'best' results for its clients, in these instances the PCTs. Best results would constitute whatever it is the PCT wants to do. Both in medicine and in other areas these public consultations tend to be cynical sham exercises. The government is hell-bent on ideologically-driven change in primary care, that ideology being 'the market'. The changes proposed for primary care are being put in place without evidence either of need or of efficacy. General practice is under threat and it is not clear whether people really know what is likely to be lost in this headlong dive into the unknown. Competing interests: None declared |
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David A Fitzmaurice, Professor of Primary Care University of Birmingham B15 2TT
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The example in my own area is that the PCT flagrantly ignored the recommendations of its own working group in re-designing the anticoagulation services for South Birmingham. I was chairperson of the working group which devised the service specifications for service providers. Despite our rejection of the proposal, the PCT has implemented a process whereby potential service providers have to register as "willing providers" and subsequently patients can choose which provider thay access. This will have the dual impact of destabilising the current service and paradoxically reducing patient choice as secondary care would not be able to bid under the current scheme. There has been no justification for the adoption of the willing provider model, which is not evidence based, nor for the downgrading of the service to an INR monitoring service, contrary to the available evidence. Meanwhile thousands of lives are put at risk due to the whims of management seeking to tick a few political boxes. It is about time the medical profession took a stand over this dismantling of our service. I was aked by the BMJ to contribute a "Personal View" around this area and may yet do so, in the meantime I feel it is important that we raise awareness of this managerial madness fuelled by political idealism. Competing interests: None declared |
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Claire L Jackson, Professor and Head of Discipline of General Practice, University of Queensland, Brisbane, Australia Brisbane, Australia, 4027
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Ara Darzi is correct when he talks of success in new primary care service delivery involving ‘change from the bottom up’. ‘Bricks and mortar’ are one piece of the jigsaw puzzle, but real change requires a sustained, multi-focal approach. The ‘beacon’ practice model, piloted by the University of Queensland in 2007/8 (1), provides the change management, model of care, professional development and governance strategies to achieve real improvements in health outcomes via integrated primary / specialist service delivery. This approach establishes a ‘hub’ or ‘beacon’ practice locally, which acts to support and extend the capacity of primary care in local practices, and better integrate them with local secondary and other state-funded care. It accomplishes this via a strong commitment to deliver a mustering point for an expanded scope of practice for primary care in areas of local population need, undergraduate and post-graduate teaching for all health disciplines, relevant local clinical research, and a focus on service innovation. This model has a strong synergy with the federated model of primary care, championed by the RCGP’s recent “Future Direction of General Practice’ document (2). Results to date have included strong relationship building between local practices, strong community buy-in, and a governance model that encourages formal partnership with a myriad of key health stakeholders to fund the care delivered. Clinical innovations have included a GP-led on-site diabetic retinopathy screening service and HBAIC levels for tertiary diabetes patients seen on-site which have decreased from a mean of 8.1 to 6.8 over the first 6 months of the service. In this evolving era of polyclinics (UK) and GP Superclinics (Australia) serving common political and community imperatives, we must take a global approach to sharing our victories, learning opportunities and plans to better serve our communities. 1. Jackson C, Marley J ‘A tale of two cities: academic service, research, teaching and community practice partnerships delivering for disadvantaged Australian communities’ MJA 16th July 2007 Vol 187 No 2 p 84 -87. 2. Royal College of General Practitioners. The Future Direction of General Practice: a roadmap. London: Royal College of General Practitioners; 2007. Competing interests: None declared |
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Anne Holmes, General Practitioner Tithebarn Medical Centre, Stockton on Tees, TS19 8RH
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Hawkes quotes Lord Darzi’s pledges. I see no evidence that they are being honoured in my practice community. I work in a small practice which was set up four years ago to provide a service in a deprived and underdoctored area. A PMS contract was awarded to a private, but GP led, company. After four years, the practice has 1250 patients, looks after a prison, teaches medical students and trains foundation programme doctors. The PCT response to the practice has been to announce, at an unrelated meeting, that they plan to amalgamate it with the Darzi Health Centre. If my employer did not choose to tender for the new service, the PMS contract would be terminated. Lord Darzi’s first pledge is that of benefit to the patients. As the practice is at the top end of performance indicators (including the prison population), I am unclear as to how our patients can benefit further. The potential detriment from loss of continuity of care when the opening hours more than double is unclear. 83% of patients are satisfied with our current opening hours. Extension of our opening hours is not currently cost effective. The second pledge is that it will be clinically driven. I am unaware of any evidence to support the plans as having any clinical benefit. ‘All change will be locally led’. The plans are led by the PCT. The consultation exercise has just started and included a leaflet drop containing details of the proposed practice changes. None of our patients were aware of the plans prior to this. The Residents Association had not been consulted. I am not aware of any local need for change. ‘You will be involved’. One might guess that the practice staff would be key partners but have not had any opportunity to have their say, other than through the public consultation process. None of our patients have been consulted. ‘You will see the difference first’. This does not appear to be in the plans and whilst I can understand that the PCT may wish to hasten amalgamation of services on one site to save money, perhaps Lord Darzi should define the meaning of this phrase. What has been the outcome to date? I do not wish to work in a system which fails to value continuity of care and which I believe will be a poor use of public funds. I am moving to another practice where I can work in a way that I believe in. I also have the more selfish motivation of wanting to ensure an NHS pension. The locality has lost a training practice and may lose more staff who would otherwise have chosen to remain serving that community. The NHS is lucky that there are so many unemployed GPs around who may not have the luxury of choosing the system in which they work. Competing interests: None declared |
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