Happy New Year

After a festive hiatus, look forward to lots of activity on the blog. Coming soon – feedback from the reference groups.

Letter from Dr Andrew Smith to Dr Jon Turvill

Dear Jon

After just completing my appraisal and been advised on the importance of reflection here are a few of my  thoughts  on last week’s Primary care Summit meeting:

Please could you disseminate to the other practices and members of the Health and Social care partnership and those involved with the PCIP.

It was good to see such a good turn out from the county at the Primary Care Summit recognising that this is a pivotal point in deciding our future way of working and safe guarding GP going forward locally. A lot of us took the time off to come and have our say and hopefully suggest a way forward given the previously expressed concerns re lack of consultation in the process. It was doubly disappointing therefore to be talked at for the whole morning and round table discussions amongst ourselves were limited and rushed and time to have an open discussion with everyone in the room was nonexistent – the main reason we were all there.

The questions we asked during the meeting were often met by the answer we do not presume to know your patients or needs more than you do – this from our BMA chair, Public Health consultant and board chair – why then not take the time to ask us? Other questions especially around CWIC and NHS 24 triage were all met with everything is fine , all good and improving – there was no evidence re the impact on other services like referral rates to hospital, A&E usage, secondary work generated. Patients who accessed the service said they liked it but where is the survey of the whole practice asking if they are happy with the service from their GP practice?  A before and after study into these factors and a comparison with how other practices with different systems are performing would surely be necessary in any cost benefit analysis before expanding a service  —  or  are we just expected to “ take a leap of faith”  as we were told.

Any way you look at it the CWIC service is an additional service alongside the GP practice – it copes with on the day demand- demand not need is going to drag the NHS down – demand in infinite- just listen to any radio phone in or pick up any newspaper and you will see how every new drug treatment and therapy is demanded and access in this day and age must be immediate. GP’s are so cost effective in the NHS as we filter demand into need and provide cohesive services which support, educate and empower patients to manage their health- we are more than a gatekeeper we save the NHS millions collectively with our day to day decisions- the CWIC service will generate more patient contacts and ergo more add on work, investigations, referrals and ultimately expense- the costs are already staggering out of our global budget and I cannot see that it would be feasible , even if desirable, to roll this out county wide let alone country wide.

The talk from the Public Health point of view was compelling and the link between social deprivation and poor health was clear to see. The factors however linked to this are low income, poor housing and lack of jobs- we appreciate the influence this has on our patients lives and support the excellent Links workers and wish for more social care availability but these issues are not fixable just at a local level. In particular I do not see any evidence that  an on the day access service is going to greatly improve the health of this very needy population- how is it going to empower them to live healthier lives?  That needs continuity of care  and  a different sort of resource. The elephant in the room from that presentation, which was barely touched upon ,was the expected huge increase in the frail elderly. Some parts of the county are already experiencing the challenges of frail elderly, housebound, isolated,lonely, polypharmacy, falls risks and multiple co-morbities. This I would say is just as big a challenge going forward as deprivation only more of the factors for managing it are amenable to local measures – increasing OT and physio resources, befriending and social centre provision, supporting GP’s  in keeping these  people at home  with realistic medicine are all possible locally were as raising income and jobs and social housing are not. Same day access centres that you have to travel too are of no benefit to the frail elderly.  Will there be any budget left to support their needs , now and in the population explosion ahead?

We all have very different populations and needs – we know these and know what we need to support them. Over time and with continuity we get to know our patients  and help them make good health decisions both  in crises and with ongoing health needs. This has proven the most economic way previously – we offer good value for money and we have high satisfaction rates.  We were told again and again how well Riverside had been listened too and how time had been spent getting to understand their practice and needs and how the CWIC service was a bespoke solution to their problem and obviously they feel if has fixed their specific problem. I hope that the board take the same approach to the rest of the practices in the county- come and take the time to understand us and see what is good in what we are doing already  and how we can be supported . We were told to “get behind the new GP contract as it is the only game in town”– please don’t let CWIC and NHS 24 triage be the only game in town for us and let it hoover up the budget or I fear the death knell.

Andrew Smith



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