A manifesto for primary care – the three R’s


I don’t know about you, but in the unfolding election campaign I see an unhealthy lack of debate and challenge on how the NHS should work.  The parties argue about money, and that only at the margins, but the opportunity for improvement lies in function, not form, and no party has understood.

Now see this week’s Lancet editorial “A manifesto for health”. “To achieve health… we must think more about issues such as education, food, alcohol, housing…”  It highlights inequity as the greatest determinant of ill health, and does not shy away from the need to tackle it.  Do read, for the largest vision for health you will see this year, and all on one page.

As a contribution to this vision, our manifesto zooms in on primary care, where we want three principles upheld, a service that is responsive, relational and professional.  Why are these counterintuitive and countercultural?

Responsive:  despite all the patient-centred rhetoric, the dominant ethos is supply led.  GP time is in slots, for patients to take them up.  When they are gone, tough.  We divert, ration, manage, fob off, whatever it’s called, because the supply is used up and your demand doesn’t fit.  The fundamental shift is to become demand led, understanding, predicting and working out how to respond to demand.  The counterintuitive finding is that free and faster service is less work.

Relational:  the bedrock of the NHS is the registered local list, having access to a doctor you know and trust.  It is a crucial driver of clinical outcomes as well as patient satisfaction.  Yet it is under threat from many sides, most of all the mistaken belief that a transactional model is cheaper.  (see how GPs are now being drafted into NHS111 centres)  Some see this as inevitable, we see it as a set of policy choices, which means that systems can and must be designed to promote relational general practice.

— A test:  have you, as a health professional, ever attempted for yourself or a relative, in whatever small way, to get around the system?  Either to get faster access or a choice of doctor?  If so, you would want that access and choice for all patients, as a matter of course, wouldn’t you?

Professional:  not only medicine but all professions have an ethical duty to provide disinterested advice.  Yet QOF and myriad other schemes have sought to pay GPs for specific actions which may not be in the best interests of patients (note the hastily withdrawn £55 dementia diagnosis bung).

These are bound to colour judgment and undermine the relationship of trust.  At the same time GPs groan under the bureaucratic burden which monitors all the schemes. Patients and GPs should unite against them.  By the way, we’ve just learned from this Manchester study that QOF has shown no benefit for life expectancy.

So there’s my pennyworth, the three R’s for primary care:  responsive, relational and professional.  Some things are more important than spelling.  My mother would be shocked.

Harry Longman

Founder, Chief Executive
GP Access Ltd

One response to “A manifesto for primary care – the three R’s”

  1. Dr Gurdev S Saini says:

    People will say this is a good manifesto, but manifesto it is. The roots of the NHS are being cut slowly and the tree will dwindle soon. All political parties are of the view that all other professional can provide the GPs work at a cheaper rate.

    The manifesto should be
    1 to free NHS from Political interference.
    2 cut the red tape in NHS to bone.
    3 remove all targets and replace with outcomes
    4 Change GP payment to one payment and set a standard and quality to be delivered. any other work moved to primary care need to be resourced. Primary care team should be bases around GPs and not other way around.
    5 reduce visit by the CQC etc.
    6 change NHS funding ratio acute to primary care. From historic to actual. Stop making general practice as the dust bin of NHS and social care or as the way it is at present anything which no one want to do give to GPs with no resource.
    7 charge tourists or treat them as private bases. With payment made upfront.

    8 stop media building expectations knowing very well that these cant be achieved.
    These are just some of my thoughts There is plenty more to save NHS a as we know.
    Regards
    Gurdev

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