The very mention of ‘sustainability’ is usually enough to send me screaming from the room, and so I was minded to skip over Tim Ballard’s editorial on the subject.1 I’m glad I chose instead to read what he had to say, as I would otherwise have missed an unusually thoughtful and thought-provoking article.
He points to the role of the GP in providing ‘high quality generalist personalised care’ and argues persuasively that such an approach is resource efficient. He extends this argument to consider the potential impact of commissioning and the opportunity this provides for avoiding unnecessary duplication of services. However, my experiences to date suggest that the precedents are not encouraging, and I have observed that most commissioning decisions made in the name of efficiency achieve anything but (unless this is the same type of efficiency that persuades manufacturers to outsource their labour abroad).
The real sustainability challenge for primary care is whether we have the courage to resist the juggernaut that is the healthcare industry and regard health care as a precious resource rather than a consumable. I suggest that every unnecessary prescription, every unnecessary screening service, and every unnecessary referral we provide for our overwhelmingly well patients is a misuse of this resource. I also agree with Ballard that we should resist taking undue responsibility for the consequences of excess consumption; much that passes for health promotion is indeed shutting the stable door after the horse has bolted, as he well describes. Again, precedent suggests that we have a way to go in this regard; how else to explain our unquestioning adoption of much of the QOF, over 50s health checks, and other ill-conceived health promotion initiatives?
Anyway, I had better stop writing now as I can see my surgery car park is filling up with the impressively fuel-efficient cars of those arriving for their health checks. While our practice nurse is seeing them, I should get on with signing the rainforest’s worth of repeat prescriptions. Funny, but the pile seems to be getting bigger all the time …
- © British Journal of General Practice 2013