Our vision: to transform access to medical care.

General practice: cunning plans vs the real thing

I suppose it’s a bit like saying, “Those new carbon fibre wheels have done wonders for my cycle speed and handling.  I know, why don’t I get a set of four and put them on my car?”

Thus we learn from this week’s Emergency Medicine Journal that all those GPs in A&E schemes don’t work.  “There are significant and unexpected consequences of simply transferring interventions that work in one setting without an understanding of context and the process of change…. paradoxical increase in demand… theoretical cost savings not as expected…

Dr Shammi Ramlakhan’s paper is free in full here

Systems thinking tells us that improvement comes about through consideration of the whole, while trying to optimise one part out of context usually increases variation and costs.

Oh dear.  Yesterday I heard another sorry tale of a GP hub scheme which had confused patients, reduced continuity and poured more PMCF £millions down the 7 day opening drain.

Let us never repeat these failures, but let’s not dwell on them either because there is work to do, and everything to hope for.

I was at the RCGP’s “GP Reimagined” event in Newcastle. Sir Donald Irvine’s call to GPs to be imaginative, bold and braverang in our ears as he concluded the keynote, and oh what a contrast to the bleating we so often hear.

Dr Ashley Liston spoke just before me in the afternoon, and I was so moved that I’ve put his story from Encompass practice in Washington here.  It’s now three years since we helped them launch a demand led system and he says not only do receptionists never cry now, he can point to lives saved.

Friends, I think we know this, and we must not be deflected.  What general practice does best, and does brilliantly, is just that:  local, list based general practice with good in-hours access and good continuity.

Let’s do it better.

Harry Longman

PS: there’s still time to sign up to the webinar Unblocking the appointment system next Friday 1pm.  Feedback from the first run on Thursday was amazement that such a simple tool could make demand and capacity so clear.  I’ll explain how you can do your own practice Loadmaster too.

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