When I was young the MSCP was a Multi-Storey Car Park, a blot on the landscape but at least my mum could park close to the shops. Now it’s a Multi Specialty Community Provider and NHS England has a plan for it.
Unfortunately it’s a plan with values on the front page, and the trouble starts there:
clinical engagement, patient involvement, local ownership and national support
If you can stay awake through all 31 pages, you’ll find a document dedicated to large scale providers with concocted supply side designs. When you look for data about actual demand, you find instead one of those made up pyramids, grossly oversimplifying the infinite variety of patient needs which all GPs experience daily. Run a mile when you see them.
There’s not a word on what matters to patients, how to measure it let alone improve it. A reminder of what matters: How soon can I get help from my GP, and for many, can I choose a named GP? The evidence base supports relational continuity, here instead we get the weasel words, “focus on the personalisation of care” in anonymous 30-50,000 lists where continuity is history. We trust our GP, we expect quality care, and as taxpayers we must also demand economy. So what is served up?
“care hubs, integrated teams, place based models of care, the primary care home”. For goodness sake, local registered list NHS general practice has been doing this for decades, and been the envy of the world.
Now they want “collaborative leadership, engine rooms, governance structures, logic models, value propositions”. Gimme strength. Straightforward persons reading that will smell a whole nest of rats.
It would be so tempting for me to say to NHS England (available spend: £100bn pa), “What a lovely plan you have there, do let me help you deliver it”, but I cannot in good conscience bring myself to do so.
“The care model will evolve as the vanguards continue to learn together about what does and doesn’t work.” p4. You can say that again. When you start without evidence, the vast majority will fail. The usual suspect case studies are wheeled out, few have ever been independently evaluated and the economic analysis is utterly lacking. As Nuffield said last week, “insufficient evidence”.
Like a supertanker without a compass, however grand and imposing, it will founder on the rocks of evidence, at eye-watering cost to us all. There it will nestle amid the rotting hulks of Darzi centres, PMCF projects, WICs, NHS111 and so on, there where the fatefully top heavy Mary Rose lay in the layers of governmental hubris.
Meanwhile, we are doing what works, reliably, repeatably, rapidly and cheaply, with providers at every scale who want evidence to back their investment. We’ll keep doing it until we find something better, then we’ll do that. Come on board.