21st August 2015

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Health Chat

29th October King's Fund 5.30pm

Samantha Jones NHSE Director of New Models of Care and Vanguards.

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Don't become a GP
News and Comment from Roy Lilley
Ok, I know; I've got this on-off thing going on with primary care. I admit it; I love the idea of family practice. Localness, knowing me and mine, someone who shouts out for us.
Someone I can trust, a confidant with whom I speak my secrets and say the things I dare not whisper to anyone else. Someone who can spot the signs, do their best and know what's what.
On the other hand; when most of us go to the train station in the morning the practice is closed. Come home in the evening it's closed. A place that thinks an eight o'clock start is early. Saturdays, there for an emergency (whatever that is) and on a Sunday... we can only go to church, sprinkle ourselves with holy water and pray for a cure.
A place we fiddle about with, on the phone, with a Mickey Mouse, press this for that and that for this. A place that registers us with an organisation and not a doctor, a place that no longer controls the district nurses, a place where our care is in the hands of an interested stranger.
I love primary care but hate what it has become.
Right, having got that off my chest; I wouldn't be a PG for all the tea in China. If I had any kids, looking for a career, I'd say better to be an inspector of manure in the lion house at London Zoo, than be a GP.
I've come to the conclusion that the combined resource of the NHS is ranged against them.
Let's start with NICE; once a trusted nimble organisation helping GPs to make sense of a complex pharmaceutical menu; what works, what doesn't, what's worth prescribing... what's not?
Now bloated and bossing everything from playground exercises to cancer drugs, it seems NICE want to punish doctors who over prescribe antibiotics. Get the GMC to strike them off.
There's not a GP in England who doesn't know over prescribing antibo'ts is a bad idea. Why do they prescribe?
Because; GPs have 10 minutes to take a history, listen to the story, look up the records, give an education session and resist being brow-beaten, cajoled and pleaded with by patients for whom public health messages are meaningless.
Because; if GPs refuse they run the risk of complaints, the CQC, the GMC and the local press.
How about supporting GPs; meaningful PH messages and a simple nurse administered, rapid test kit that can detect the difference between a viral and bacteriological infection (like they use in Finland, Sweden, Germany and Norway); so patients can see for themselves what the score is.
Oh and that brings me to the CQC. Their latest wheeze is to close practices. Dodgy practices we can do without. Close them? Let's think about that.
What happens to patient choice, what happens to practice overdrafts and commercial leases and borrowings? What happens to clinical staff and administrators and managers? Oh, and who subsumes the patients on the list. What happens to their choice? What happens if the local practice lists are choc-a-bloc?
How about getting a team of people into the practice and help sort it out? Show them what good looks like.
There are not enough GPs and too few young doctors who want to become GPs. The direction of policy is to have more care carried out in primary care, by GPs.
Is there anyone left in Whitehall still thinking? We need more GPs, that means making the job attractive and doable. We need to sort out quality issues because, to deal with demand, we need all the practices firing on all cylinders.
We can't sack GPs because PHE can't hammer home health messages that resonate with the public.  We can't close practices because the CQC have not the wit to figure out how to keep them open.
Regulation, neglect and stinkin' thinkin' is destroying the foundation of our health system and the RCGP and the BMA look to me like spectators as the wrecking ball demolishes the roof. 
Noel Coward might have been right when he wrote, in 1947; 'Don't put your daughter on the stage Mrs Worthington' In 2015 the message is; 'don't let your daughter become a GP'.
Have a good weekend. 
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Roy Lilley 
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... and NHSE Director of New Models of Care
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King's Fund
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