Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
Intended for Healthcare Professionals
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
The Back Pages

NHS REORGANISATION: CAN GPS DO IT?

Nigel De Kare-Silver
British Journal of General Practice 2010; 60 (579): 779. DOI: https://doi.org/10.3399/bjgp10X532468
Nigel De Kare-Silver
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

NHS REORGANISATION: CAN GPS DO IT?

NHS reorganisation is upon us again1 with a change of philosophy and reversion to a strengthened, practice-based, commissioner-provider split. Since the announcement of this change and the subsequent White Paper, there has been a wealth of criticism.2,3 The objections fall broadly into several themes: some of which are evidenced4 and need little comment, but however, it is an observation that each new health secretary will make it clear that they intend to leave their personal organisational stamp on the NHS, regardless of any evaluation or estimate of transition costs. It is within these transitional periods though, that the high-minded, optimistic articulation of concepts become lost when translated into the reality of health service delivery.

Thus, there is a very real risk that existing services, in need of radical change, will remain in a stagnant state as local groups focus on a renaming process: for example, the re-labelling of community hospitals as polyclinics, because this is the simplest way to deliver the system changes demanded.5 That change is imperative however, can not be understated. The NHS has been promised it will be spared reductions in income but this is against widely accepted predictions on the demand in growth over the next 5 years for which there will be no additional funding.6 The changes of the past 10 years with successive creations of PCGs, PCTs, and practice-based commissioning have all been heralded with announcements that the organisational names reflect the importance of empowering general practice in decision making for configuration of local health services. All have failed to deliver this as the headline announcements have been superseded by processes and priorities dominated by managers’ agendas and not those of the primary care practitioner.

To accuse GPs of being incapable of this work is a fallacy which must be dismissed. GPs are, quite frankly, some of the most intelligent people of their generation in the country. In addition, those GPs emerging from training over the past 10 years or so have been subject to assessment systems throughout their specialty training programmes which are by and large becoming incrementally tougher.

GPs will have to work with managers in this system. They must ensure they make it clear they retain the executive role and not allow themselves to become lost in management and operational issues. They must learn to discriminate between these two important large organisation functions of executive management and operational issues and be leaders of change rather than stalled in the change programmes of others. They must seize the initiative and use the time vacuum where Andrew Lansley is transmogrifying his ideas into practicalities, the opportune vacuum of the blank page, to identify their local needs, priorities, methods and structure before this is imposed on them.

Moreover, GPs must be realistic that there will be inadequate funding for the range of services aspired to or centrally required regardless of the processes and systems in place. They do not have to feel obliged to apologise for being unable to deliver a list of services and requirements when this is a result of inadequate resources, nor work themselves for inadequate remuneration in order to seek a financial balance. They must be prepared to stand up and declare that directions from others in the NHS, national or regional bodies, be it services or the governance processes to support processes deemed prerequisite, are unsustainable when the funding simply does not support this.

The current proposals1 are exciting and invigorating but demand GPs show leadership, initiative and enthusiasm before the managers contrive to reassert their positions in the NHS, a position long associated with stagnation, inefficiency and complaint. It is vitally important that GPs are on the top table7 in system redesign and do not fall into the systems once built by others without clinical experience or expertise.

  • © British Journal of General Practice, 2010.

REFERENCES

  1. ↵
    1. Secretary of State for Health
    Equity and excellence: liberating the NHS, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 (accessed 31 Aug 2010).
  2. ↵
    1. Walshe K
    (2010) Reorganisation of the NHS in England. BMJ 341:c3843.
    OpenUrlFREE Full Text
  3. ↵
    1. Ham C
    (2010) The coalition government's plans for the NHS in England. BMJ 341:c3790.
    OpenUrlFREE Full Text
  4. ↵
    1. Smith J,
    2. Mays N,
    3. Dixon J,
    4. et al.
    A review of the effectiveness of primary care-led commissioning and its place in the NHS. http://www.gloslmc.com/guidance/previous/PC%20led%20commissioning%2005.pdf (accessed 31 Aug 2010).
  5. ↵
    1. Ham C
    (2009) The 2009 budget and the NHS. BMJ 338:b1760.
    OpenUrlFREE Full Text
  6. ↵
    1. Appleby J,
    2. Crawford R,
    3. Emerson C
    How cold will it be? Prospects for NHS funding 2011–2017, http://www.kingsfund.org.uk/document.rm?id=8423 (accessed 31 Aug 2010).
  7. ↵
    1. De Kare-Silver N
    (2010) NHS cuts and services: can we afford it? Br J Gen Pract 60:218–219.
    OpenUrlFREE Full Text
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 60 (579)
British Journal of General Practice
Vol. 60, Issue 579
October 2010
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
NHS REORGANISATION: CAN GPS DO IT?
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
NHS REORGANISATION: CAN GPS DO IT?
Nigel De Kare-Silver
British Journal of General Practice 2010; 60 (579): 779. DOI: 10.3399/bjgp10X532468

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
NHS REORGANISATION: CAN GPS DO IT?
Nigel De Kare-Silver
British Journal of General Practice 2010; 60 (579): 779. DOI: 10.3399/bjgp10X532468
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • NHS REORGANISATION: CAN GPS DO IT?
    • REFERENCES
  • Info
  • eLetters
  • PDF

More in this TOC Section

The Back Pages

  • How to protect general practice from child protection
  • Who Is My Patient?
  • Working with vulnerable families in deprived areas
Show more The Back Pages

Viewpoint

  • The NHS: have the rivets popped?
  • Bring Hippocrates to the people and save the NHS
  • Getting the swagger back into general practice
Show more Viewpoint

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2022 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242