We welcome the announcement that new investment is to be made into primary care (Osborne under fire over £2bn NHS pledge, 1 December). However, it is not all about the money. GPs are on their knees, new GPs are scarce, there is a developing fracture between patient and doctor due to a mismatch in expectation and reality: general practice is at a tipping point. It’s time to let go of the old order. We must stop being heroes and heroines. Working 12-, 13-, 14-hour days is not heroic. It affects our ability to provide safe and consistent patient care; it affects our family lives; it affects morale and job satisfaction. We chose our roles in health to provide care, to diagnose and heal – not to push paper around late into the night.
As GPs, we have to accept it’s not all about us. It’s about a much bigger picture. We need to work with people to stay well. We need to put silos and fragmentation behind us and work collectively with our colleagues in pharmacy, in hearing and eye care, and our consultant colleagues in hospitals. We need to look forward, although without losing the traditional values of family medicine and locally based health services; values that deliver personal care and continuity and build on the assets of the communities in which people live and work. Healthcare in the future will look and feel different. It won’t divide neatly into primary and secondary care. It will become part of a wider system, one where the edges blur and dissolve. One in which we must all play our part as responsive and responsible citizens.
We propose that part of the new funding supports a new role, a community health connector that enables us as health professionals and as people to create healthy communities that support the new models of care that will sustain an NHS that remains free at the point of need for everyone.
Dr Michael Dixon
Chair, NHS Alliance, and GP, College surgery, Cullompton, Devon
• There is absolutely no question of slowing down on our review of urgent care, which has attracted a broad coalition of support (A&E shakeup dropped over fears that it would be political suicide, 1 December). Indeed, it is a central part of the widely welcomed NHS five-year forward view and the pace is about to accelerate. Sorting out the urgent care system is one of the most important priorities for the public and for the NHS. We have to ensure patients get the right care at the right place, first time.
The heavy lifting starts in 2015-16, which will include the formation of urgent care networks to include all hospitals with A&E departments across England. We then expect networks to identify the 40 to 70 emergency centres which have specialist services. We have always been clear that we expect the total number of urgent care centres to remain broadly the same. I would not want any one to get the impression that we are slowing down or backtracking on such an important project for patients.
Professor Keith Willett
National clinical director for acute care, NHS England
• David Owen cites Scotland as an example of the people power he hopes can be harnessed to preserve the NHS and prevent the inroads of marketisation (How to take back the NHS before it’s too late, 1 December). He might have added that Scotland, having abolished the purchaser/provider split under a Labour administration in 2004, is in a much stronger position to do so, as well as spending a much lower proportion of its health service budget on management than England.
Given the already fragile forms of democratic representation and accountability in the NHS, it is difficult to see how the “new democratic way of exercising the power of the people” that he recommends can be effectively applied, short of a referendum. Increased marketisation and the accompanying commercial secrecy, as exemplified by the TTIP negotiations, will weaken the process still further. Both old and new forms of political pressure need to be applied, in particular to the Labour party, to address the question as to why the leadership has not been prepared to follow the 10-year example of their Scottish colleagues. As with the lead-up to the Scottish devolution referendum, a campaign for an NHS constitutional convention could be the galvanising factor required to restore the NHS to its founding public service principles, with sufficient popular support to prevent all future efforts to dismantle it.
Dr Anthony Isaacs
London
• I recently received a letter from the CQC advising me that they wish to come and interview me about my role as a manager. I am a GP partner and have not recently undertaken any new roles; ideally, I would like to spend my time seeing patients, although current restructuring of general practice does take me away from the frontline for increasing amounts of time. Over the past month, the byzantine processes of the CQC have required me and my practice manager to complete reams of paperwork to register me as a “manager”. I currently work a 12- or 13- hour day, amounting to 50 or 60 patient contacts, as well as letters, prescriptions and so on. I am informed that this interview will take about an hour. Don’t worry: the CQC registration inspector works flexible hours so she can come at weekends if I prefer. I don’t work flexible time – I work until the job is done.
I successfully completed revalidation in July 2013 – which includes review of non-clinical work. This CQC process is consuming valuable clinical time and financial resources to repeat a paper exercise for which there is no evidence that it improves patient care or patient safety. There is, however, considerable evidence of GP burnout and early retirement – to which the CQC makes a notable contribution.
Dr Rachel Cottam
Park Crescent Health Centre, Brighton
• The GP practice in Newton Abbott might have taken the advice to seek help elsewhere too far (GPs told patients to go elsewhere for basic treatments, 2 December), but the basic principles of the leaflet are sound, namely: 1) the public can now get help from an increasing number of NHS services (eg physiotherapy, mental health services and of course pharmacies) directly without having to go through their GP, which may well make access easier, faster and more convenient, with online self-referral for example, and furthermore direct access to psychological therapies is national policy; 2) the demand on GP practices is huge and ever-increasing, and outstripping supply. If patients who are able and willing to refer themselves directly do so they might well receive appropriate care more quickly and easily, and this would also make a few more GP appointments available for those who really do need and want them.
GPs are expected to do everything from prescribe drugs and infant feeds for small babies at the request of paediatricians to complex drug regimes for the terminally ill, we deal with a huge range of people and problems daily. As Atul Gawande said in his second Reith lecture on 2 December, the volume of knowledge and skill in medicine has exceeded our individual capabilities, and this is certainly true in general practice. Too much is expected of GPs, who must work as part of a system which delivers safe and effective healthcare, which can include patients self-referring to certain selected services.
Dr Stephen Ball (GP)
Woodbridge, Suffolk
• Small wonder that NHS England disapproves of the Kingskerswell and Ipplepen GPs who have the honesty and the willingness to communicate the steep decline in standards of care as a result of coalition cuts (Report, 2 December). The rest of us have practices forced to paper over the cracks, pretend that everything is as normal and communicate as little as possible about the deteriorating state of this part of NHS work.
Hugh Cooper
Charing, Kent
• It makes no sense for the chancellor to promise extra money for the NHS while continuing to cut local authority social services budgets. Ambulances will still be waiting outside hospitals with their patients, beds will still be blocked and waiting lists will still grow if adult social services can’t fund residential care and domiciliary support for older people. The social service budget needs to be ringfenced – just as the schools budget is – and restored to the levels this government inherited.
Blair Mcpherson
Sheffield
• I write to you from a hospital bed in Gloucester Royal Hospital, and feel compelled to put pen to paper. I have sat here (particularly this week), reading on my news app about the NHS in crisis, and all the problems.
I want to write to tell you a completely different story. I was admitted with suspected pneumonia at the end of last week. From the GP who saw me in the out-of-house clinic, to the paramedics who waited for my crying children to get in the car and leave before putting me in the ambulance, to the doctors and especially nurses who administered to me when I first arrived, they were all amazing – every single one.
Now, I do have to tell you that I am in one of the oldest parts of the hospital, and not everything works quite the way it should. It’s a bit battered around the edges, and the staff sometimes have to scout around for the “one that works” – not clinical equipment, but those bits and pieces that you need when you have people to stay.
But despite any of that, it has been the most amazing experience, and I have met truly delightful people. To be honest, I wish I had taken notes – though I certainly wasn’t well enough – because it has been a myriad of good deeds and kind words.
And do any of these people ask for any adulation for their hard work? Do they complain when the papers and the politicians run them down? Well, perhaps just a little bit, but wouldn’t you?
Jane Lee
Chalford Hill, Gloucestershire
