LMC Chairman's blog
I’m often asked, not least by myself, how I got into All This. I’m not hewn from traditional medico-political oak, unlike some of our more strident colleagues of national fame, in whom, if you were to chisel off a limb, you might find the names of Aneurin Bevan, or great GP leaders of the past, burnished through the grain. For the first 10 years of my GP career, my medical ambitions outside the consulting room were confined to occasionally startling, all too briefly, the scorers for the Bridgwater Doctors Cricket Club, popping along to the Medical Club functions at the Castle Hotel in Taunton, and spending occasional weekends away, either in the UK or abroad, enjoying the company of colleagues and learning about new asthma drugs and statins. It was mainly statins: diabetes was insulin, metformin and sulphonylureas, and dementia hadn’t yet been invented.
Hey- great job, everybody! We’re all winners again, so gongs all round, no doubt. For the second year in succession, the Commonwealth Fund has named the NHS as the best overall healthcare system in the world. Hurrah. The US came bottom of the list, with 44% of the population on low incomes having difficulty accessing healthcare (compared to 7% in the UK). In a comparison across 11 countries using five quality measures, and taking data from the WHO, the OECD and questionnaires completed by doctors and patients, the UK was ranked in the top three for all categories apart from health outcomes, where it was second-to-last, ahead of just the US. But the report went on to say that while the UK ranks 10th in the health outcomes domain overall, it had the largest reduction in mortality amenable to healthcare during the past decade. So that’s encouraging.
In the months and years before I became gavel-monitor, I used to worry about the system going bosom-side up on my watch. I stopped fretting sometime last year when I realised there was little point, and I couldn't be expected to single-handedly save the NHS. We all know we're heading for a crash, but we've been doing our best to steer the thing gently into a hedge so as to limit the damage, and at least have some sort of battered wreck with wonky wheels and dented doors, in which to limp away afterwards. What we hadn't really expected was to find the PM herself hunched over the wheel of the oncoming juggernaut that threatens to wipe us all out.
In times of stress and uncertainty, whether personal, professional or global, it's probably wise to have a plan. I'm sure it has absolutely nothing to do with the US election result this week and the prospect of Uncle Donald playing keepy-uppy with the nuclear football, but recently I found myself perusing an old "Protect and Survive" leaflet.
You've got to hand it to the government- they couldn't be more in touch with us hackers and hewers at the NHS coalface if they arrived with their gold-plated picks and got stuck in themselves. The problematic nub of GP morale has now got the podgy digit of Health Minister Philip Dunne well and truly on it. Speaking at a fringe event at the Conservative Party Conference in Birmingham on Monday, Mr. Dunne said that Uncle Jeremy had decided that what would really improve morale is a shedload of awards and gongs for GPs, and that recognition of this sort could provide ‘self-motivation’ for staff. So- darn the cardy and buff the brogues, we're all off to the Palace to meet Her Maj. Hurrah!
Kevin Pietersen and Katie Price must be chuffed as nuts- KP nuts, you'd presume- that somebody with the same moniker, has found themselves dumped into the limelight and is now taking the sort of flak previously experienced by the preening ex-England cricketer and the pneumatic reality person. The former CEO of Southern Health (a community health provider covering Dorset, Hampshire, Oxfordshire and Buckinghamshire), Katrina Percy, has recently resigned under a cloud, and taken a sideways move into a new role created solely for her, and for which she is, we are told by Tim Smart, the Trust chairman, "uniquely qualified". She is providing "strategic advice for GPs", and has retained her previous salary of £240,000 per annum (that equates to the whole funding of our LMC for a year). I'd be interested to hear how her local GPs and the LMCs view her “unique” qualifications, and would suggest that for that sort of folding money, the advice must be pretty extraordinary. It would be a cheap and easy jibe to suggest that she is her own Sustainability and transformation plan (STP)- sustaining her lifestyle whilst transforming herself into some sort of Primary Care guru- a mystical figure sitting atop the highest point in Wessex, waiting for baffled and bewildered GPs to clamber up and ask her strategic advice, but times are hard so there you are. Here in Somerset we have our Provider Support Unit (PSU) which has taken the last 12 months to develop with LMC, legal and accountancy input. It is designed to provide all the basic documentation and answer queries practices might have when considering collaboration or integration, for example. All federations bar one have signed up to use it. I’m not sure what strategic advice Ms. KP is qualified to dispense, but on the basis of cost alone she must be able to sort out all sorts of other niggles GPs might have.
This is almost certainly my last blog, as I’ve been head-hunted for a new job. I know I'm only just getting into my stride with the chairing thing, and actually quite enjoying it, but this sounds too good an opportunity to miss. Somebody wants my services and has been desperate to get me to apply, hassling my Practice Manager on an almost daily basis. It must be a staggeringly responsible position, given the hoops I'm being asked to jump through. I need yet another DBS check (that's £61.50 I won't see again), and I'm assuming that all the convictions, cautions, reprimands, warnings, restrictions, injunctions, super-injunctions, banning orders or register entries that I may have had in the past are now either time-expired or lost, given my current job as a GP, which can feel pretty responsible at times. I’ve been involved with Child Protection conferences and also Professional Performance discussions, but such is the profile of this new role that it demands a whole new level of scrutiny, and an even deeper dive into my background. Yesterday I had to present myself at the Post Office for an identity check. My passport alone was not a sufficient guarantee of who I was (ponder that the next time you're in one of those serpentine queues at BRS border security), even when presented with my driving licence, which I also had to produce. No- what clinched it was a copy of a mortgage statement from First Direct. This was curious on a number of levels, not least that it doesn't give my address or any other identifying features apart from my name and account number, and in fact all it proves is that we chose to give our daughters plenty of opportunities to play hockey, learn the bassoon and mix with the spawn of Russian oligarchs, rather than paying for the house. If I pass the DBS bit, I'll be on a similar security setting to the PM (that's Prime Minister, not Practice Manager). We haven't discussed salary yet, but I'm anticipating it will be colossal, given that the income of the organisation has risen so dramatically in recent years. I'll need to drop a few days of other work to do the job justice, and won't have time for any fun stuff like this. So what is this amazing opportunity that beckons me away from the Blogosphere? I'm thrilled and humbled to announce that the Care Quality Commission wants me to be a “Registered Manager”.
I used to enjoy August. Tales of kitesurfing donkeys and vegetables shaped like Kylie Minogue made the front pages of the papers, simply because there wasn't any other news. The world would quietly shut down for the month to go on its hols, and our practices were quieter as well. This year it's all rather different- Trump, Rio, Brexit and the calamitous state of the NHS have, between them, kiboshed the natural order.
The locum situation, previously merely dire, is now as critical as it has ever been. We know from the locum agency that there are hundreds of locum requests for August that they will be unable to fill. Not only are exhausted doctors unable to take much-needed leave, but it has also meant some of us haven't been able to get away to attend important meetings that crop up these days at increasingly short notice. It's becoming a real problem getting proper GP representation if we can't escape from our practices. The tight time-frame demanded by Simon Stevens for delivery of the STP has meant weekly meetings being arranged during August. Our practice manager made a gentle enquiry of the agency to see whether there was any possibility of a locum- she was told in no uncertain terms that there was no chance, and why do people arrange meetings in the holiday season in any event? The reality is that we simply can’t afford the luxury of waiting for things to calm down- it’s not going to happen- the whole thing is built on quicksand, and sinking.
So what do you think of the new stuff on the web social media enticing GPs to come and work in Somerset https://gpinsomerset.com (twitter @GPinSomerset)? Jill and the team have done a great job, and if I wasn't gainfully employed here already, I'd certainly be tempted to up-sticks and apply for something locally. I might even delay my retirement. Apparently we have to get anybody on Facebook https://www.facebook.com/GeneralPracticeSomerset) to "like" it, and share it and then it sort of...er...takes off somehow. Obviously (and evidently), I don't do Facebook myself, but do follow Twitter, and that's certainly been one way to try to keep abreast of all the geopolitical shenanigans over the past 3 weeks or so. @drphilhammond is an entertaining one to follow for NHS stuff (not to be confused with Philip Hammond, the new Chancellor).
It's been a busy week since getting back from France. On Monday evening we held our CRG/executive meeting, and went through the agendas for Thursday's meetings. We also discussed what implications the Brexit vote might have for the NHS. The truth is, of course, that at the moment nobody can possibly know. Before the vote the Chancellor had been clear that there would need to be an emergency budget after a "leave" result, and that there would be cuts to the NHS. On the other hand, the Brexiteers had promised extra funding for the NHS, although they rolled back from the 350 million that they emblazoned on their battle-bus. At least when the NHS appeared to be in a state of chaos just a few weeks ago, there appeared to be some sort of order around it. Now all that has changed. Any further cuts would surely destroy any pretence that the NHS can survive, and the result of the vote and ensuing chaos are likely be used as an excuse for future failings in the system.
My first brush with Somerset LMC was in September 1983, and to be frank, I wasn't that impressed. As a final-year medical student, I spent half of my entire undergraduate GP training- 2 whole weeks- at French Weir Health Centre in Taunton. One of the partners was Richard Tiner, who was then Medical Secretary of the LMC. He invited me to attend a meeting, which in those days were held upstairs in the old County Hotel, now Waterstones. To get to the meeting evidently involved a difficult journey through the bar, which I'm told could often take an hour or so, and by all accounts meetings were convivial affairs. Imagine my disappointment then, to be told that I wasn't welcome, and the Chairman had decreed that it would be inappropriate for a medical student to attend. I probably had something better to do anyway, but I know that Richard felt very embarrassed about the episode, which I do remind him of whenever I meet him (he left General Practice to become medical director of the ABPI, but still lives locally). I keep meaning to look up the minutes of that meeting to see what it was that I missed. I hope we are a bit more inclusive these days, and it's quite common for registrars or established GPs to attend meetings as visitors.
I hope most of our punters have at least heard of the STP (Sustainability and Transformation Plan). This will be the most significant document yet produced in setting out how our local health system plans/hopes to get through the next 5 years. If you haven’t read it yet, I’d urge you to spend 15 minutes or so looking at this excellent critique of STPs - Link to document.. The requirement for each ‘Local health System’ to come up with its own plan was outlined towards the end of last year as part of the implementation guidance for the 5 Year Forward View (itself published in October 2014), and I think speaks volumes about where we are. The implication is that the system is broken and heading further and further into deficit, and the centre now would like us to sort it out. Note that it talks of ‘Local health Systems’ rather than CCGs. Failure to come up with an STP that meets approval from NHS England will mean that areas will not be able to access Transformation funding. There are 44 ‘footprints’ nationally- each covering a population of (on average) 1.2 million people. We are fortunate that our STP covers the whole of Somerset- some footprints will cover populations served by up to 15 CCGs! Each area had to select a Senior Responsible Officer to oversee the production of the plan in a very tight timeframe, and we are one of only 4 in the country to have an SRO with a Primary care background (Dr Matthew Dolman).
This is the first of what I intend to be a fortnightly blogette, an insight into what being the LMC Chair involves, and some personal musings on the role and the state of the NHS around us. This is intended to be a personal account, and is not intended to be taken as LMC policy!