‘A radical restructuring with bigger and better organised practices, and units of 30 000– 50 000 patients, is needed. This will afford economies of scale, diversification in careers, standardisation, and less chaotic working.’1 I applaud the sentiment, but there are some assumptions that worry me:
The pain of repeated radical restructuring is possibly the worst part of being a doctor in the UK, however well motivated the orchestrator and however good the ideology.
‘[B]igger and better organised.’ I presume a causal relationship is suggested.
I hear this over and again from colleagues at locality and PCO level. I fear the hand of McKinsey and the like. We have all worked for bigger NHS organisations. The experience is often what drives a doctor away from hospital medicine. My personal and ongoing proxy experience of bigger NHS organisations throughout the service is chaos, waste, poor management, miserable workforces, a bullying culture, and the institutional inability to understand professional autonomy. Quite awful reliance on over-sold IT systems and the use of ‘Information’ (the illegitimate child of fundamental data and communication). I have only ever seen one genuine example of ‘economies of scale’: paper is a little cheaper when bought in bulk.
Diversification in careers: doesn’t this presuppose that general practice is, in fact, a non-career; a second class specialty? Just what the article seeks to reverse. Standardisation and less chaotic working can surely only happen where the patients only have one illness?
- © British Journal of General Practice 2016
REFERENCE
- 1.↵