I’m going to make enemies in this blog. Not because I want any more, but because I’m asking for critical thinking, evaluation of evidence, judgment.
The zeitgeist says “no one size fits all”. It’s even written into the NHS Five Year Forward View, page 16. In a postmodern world anything goes. Now anything goes in your choice of hairstyle, if you have the luxury, but anything goes in how to run a supermarket, how to build a car or how to treat a wound? Wherever you are in the world, they are almost identical. Other methods have been competed to the margins or out of existence.
The 5YFV obsesses about structures, yet is ignorant on systems. And when it comes to “how to operate a general practice”, what do we hear from the colleges, the NHS, commissioners and so on? Suit yourself. Nobody knows what matters, so have a go and who cares?
I think there’s a reason for this. Lack of proper measures, lack of transparency and accountabilty and yes, lack of competition all keep patients in the dark. Patient Experience Surveys are useless for operational and quality comparison, and the CQC makes things worse by tick boxes, fluffy commentary and ratings bearing little relevance to patient concerns.
What is the patients’ first concern? The ease and speed of access. Another study (Sirdifield) just said the same thing again. Now consider the variation in performance: a well known London practice told me last week “we don’t do same day appointments” and offered me a 22 day wait. This Thursday I was with Chris Peterson from The Elms, big smile, doing better than ever, his patients wait a median of 12 minutes for the GP to respond in their demand led system.
That’s 32,000 times quicker. But CQC takes no notice.
Friends, we don’t need endless pilots, 75 new models, 10 “high impact” ideas which aren’t. We need relentless pursuit of what we already know works. We need innovation, local adaptation, testing, refinement, yes, but no more mushy, fudgy, bumbling along. We can’t afford it, patients are being let down and GPs are needlessly wearing themselves out.
New enemies and old friends, please bring your evidence and let’s debate. Twitter GP journal club #gpjc this Sunday 20/3 at 8pm on telephone triage – we must do better.
Best regards, Harry Longman
PS The operating system makes all the difference but size per se seems to have no impact on cost. Important to read this paper to the end as the conclusion changes!