Trumped

Friday 11 November 2016

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.

For the benefit of our more callow colleagues, this was a publication produced by the government in 1980 (and an accompanying public information film) that was to be distributed to every household in the cheery event of nuclear war being deemed imminent. I remember some tense and scary moments in the late 70's, particularly when things were kicking off in Iran, which spawned a variety films and programmes, the most famous of which was Raymond Briggs's "When the wind blows". In the event of nuclear conflagration, the Protect and Survive leaflet would probably have been about as useful as the whistle on your lifejacket if you've just spiralled into the Atlantic from 36,000 feet, but is both naive and chilling in equal measure. At least it aimed to provide some basic, common-sense information and advice, along with handy checklists for a family trying to live for 2 weeks under a couple of doors covered with bags of earth, including a reminder to remove the chain from your lavatory (nope, no idea either), and how to bury your dead relatives.

Not that I'm worried at all, you understand, but for the past six months I've been stocking our cellar with baked beans and bottled water (4 cans, 6 bottles at a time from Lidl- I didn't want to arouse suspicion or create panic- the checkout girl no doubt recognises me now as a lonely saddo of dubious taste, limited means and flatulence). I can't quite remember now why I started hoarding supplies and taping up the vents: whether it was because I was concerned about the prospect of incineration after His Donaldship got irked by an inflammatory Tweet at 3 o'clock in the morning, or maybe it was because the Sustainability and Transformation Plans (STPs), developed largely in secret at the insistence of NHS England, were threatening to explode onto the scene with significant collateral damage and fallout sometime in late autumn?

I'm aware that the last Chairman's blog seemed to have a cyanotic tinge, or at least a melancholy hue. It probably just reflected my mood at the time, so I'm delighted to be able to relay some positive news. Consultant and Urgent Connect, which enable GPs to talk with consultants about problems that might avert a referral or admission, are now up and running. Practices should have received their phone contact details, and there are serried ranks of consultants lined up across the county ready to take your call right now. OK, it might not be quite like that, but certainly in other parts of the country it appears to be working well, and it's really important that we get this sort of thing to work. The loss of ability for GPs and consultants to talk directly in real time about clinical conundrums is top of the list of gripes that most of us have about the modern primary/secondary care interface, so let's make the most of it. EMIS viewer is also proving its worth in the ED and MAU according to early reports from the trust. It all proves how critical dragging the communication interface into the modern era (OK- late 20th century) is for any of this joined-up stuff to work.

Earlier this week I was in Yeovil to meet again with the STP and CCG leads. We went through the planning document they have produced for the Primary Care workstream of the STP in some detail, looking for areas where the LMC has already been involved and trying to link it with current work already going on around the county. We've also been keen to identify funding that flows down to the CCG from NHS England as part of the GP Forward View, and to make sure it gets to where it's intended without undue delay or hold-up.

By the time you read this, the STP will have been made available to practices. A variety of documents, varying in length and detail, were released this Thursday, and I would urge you to read at least the shortest version. Primary Care is absolutely fundamental to the process, and to the way that each of the workstreams (Primary Care, Community Services, Acute services and Prevention) work, and the real challenges lie ahead in the "doing" bit. We have been giving some thought about how best we get Primary Care represented on the implementation groups. There is clearly a role for the LMC, but I'm mindful that we have to be in a position to support every practice, and probably need to have some distance between ourselves and the decision making process. Who has a mandate to represent Primary Care? What role could Somerset Primary Health (SPH) play? We are planning to use part of our Confederation meeting at the racecourse on November 15th to discuss these matters further.

On Thursday I attended a meeting at Musgrove to discuss the formation of an Accountable Care System for Somerset. The meeting was chaired by Bob Deans, the recently appointed System Turnaround Director for Somerset, who has been in post for a week or so and had to get himself up to speed with the local situation. As such, he was legitimately able to ask some fairly basic questions and issue challenges to the local leadership. Our own Steve Edgar gave an upbeat assessment about the impact of Enhanced Primary Care in his practice, and there were questions about how successful initiatives could be rolled out across the county. There was a palpable sense that things are going to happen quite fast, starting in South Somerset, although it was clear that there are still some basic concepts that need to be discussed between the FTs and also with the leadership of the County Council, who look after social care.

One thing that you can rely on in the modern NHS is that the meetings come thick and fast, budding further meetings as they go. The pressures on the emergency departments and MIUs are well recognised, and at the weekend I heard that I'd be attending an Integrated Urgent Care Summit, hurriedly arranged for a date in early December. Ironically, our usual representative can't attend, as he will be at the Accident and Emergency Delivery Board being held at the same time. (Hmm- some overlap here I suspect). At all such meetings, it's tempting for the MIUs and EDs to look at Primary Care and ask what we can do to reduce demand on their services. We make no apology in pointing out to them that if our capacity to see patients in Primary Care fell by just 10% (it's not hard to see that happening if a practice failed), those patients would double the workload of the Emergency Departments if they rocked up there, which might be just what they choose to do.

Alternatively, they could follow the advice in "Protect and Survive" and cower in their shelter for 2 weeks, clutching a toilet chain, dabbing themselves with a strong antiseptic and grazing on baked beans. On reflection, perhaps taping up the vents was a mistake.

 

Nick Bray

November 10th 2016

 

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