In his book The Five Health Frontiers: A New Radical Blueprint, Christopher Thomas describes one of the main threats to the NHS. Bevan himself recognised that the NHS had to provide a comprehensive health service otherwise those people who have the finances will choose to ‘buy-out’. They will pay to vault over the waiting lists or they will find other ways to get the best possible treatment. It is not enough for the NHS to provide a base level of services, a mere safety net, or it will wither. It has to be as good as one can get.
Phil Whitaker has written wonderfully on the GP crisis in the New Statesman, and in March 2022 he noted that a new GP contract was needed. Many would agree but the 2004 new GMS contract is not a good example. Many GPs, myself included, would regard it as a misstep; it heralded the arrival of QOF and GPs ceded control of out-of-hours care. While it wasn’t the birth of bureaucratic micromanagement of daily professional practice, it was put on wheels with parlous effects for GPs and patients.
Any new contract needs to serve a long-term strategy to sustain and revitalise general practice. Where is that strategy? Joe Collings was an Australian GP who ended up in the UK seconded to the Nuffield Trust. The ‘Collings report’ was just 30 pages long, published in March 1950 in the Lancet, and had a huge influence on policy. As Gerald Gill reported in an excellent article in the BJGP in 2020, An Australian reflects on the Collings report 70 years on, the Collings report angered plenty of people, and he described Collings as the NHS’ first whistleblower.
We need a full independent review of general practice in the UK led by a GP willing to speak hard truths to power. The problems with workforce and working conditions are piling up and are well documented. We know the workforce problem will not be resolved quickly; it will take a generation to truly address the difficulties. There are, of course, immediate measures but they need to dovetail with a longer vision.
There are some uncomfortable discussions to be had — an obvious one is the debate around the nationalisation of general practice. The knee-jerk response from many is to dismiss it. Yet, as Christopher Thomas points out, parts of the UK where the partnership model is not functioning are already seeing privatisation.
In February 2021, Operose Health, a subsidiary of the US company, Centene, acquired AT Medics who operated 49 surgeries. The former CEO of Operose Health, Samantha Jones, is now working in No.10 as the Chief Operating Officer and Permanent Secretary for Downing Street. Yet, the discussions are complex and we have to guard against tribalism. AT Medics had previously been owned by six GP directors. That already feels a long way from the traditional model of GP partnership we associate with the best relationship-based care and the precious continuity of care eloquently detailed in Sir Denis Pereira Gray and colleague’s editorial this month.
| The four editorials this month all link up. The workforce is struggling and suffering; yet we certainly need continuity of care to ensure we value the role of gut feelings in the diagnosis of cancer. In analysis this month we cover a novel method of quality improvement and the role of prevention in practice. In clinical practice, the article on home blood pressure monitoring deserves close scrutiny, and we cover the recent NICE guidance on managing chronic pain. And one must-read research article is about why GPs rarely do video consultations and when they are still useful. |
- © British Journal of General Practice 2022
