I have found the last year as your regional representative to the General Practitioners Committee (GPC) of the British Medical Association (BMA) somewhat challenging. The challenge has been getting your voices heard at a national level.
The Meldrum Review
A few years back, Dr Chaand Nagpaul (current Chair of the BMA and former Chair of the GPC) invited Dr Hamish Meldrum (former GPC and BMA Chair) to review the form and function of the GPC. The “Meldrum Review” as it has come to be known resulted in fewer meetings of the GPC as a whole and more delegated authority to the GPC Executive teams to get on with the job representing us all. Whereas we used to gather almost every month as a committee to discuss topics and solutions, we now gather a total of 7 times per year.
At face value, the concept seemed great. The expected outcome was a reduction in expenditure associated with travel, accommodation and honorarium costs and a freeing up the Executive Committees from having to report about their activities every month resulting in more time for them to deliver outcomes. I was in favour of this and voted to proceed with a pilot of the reform.
However, here I am now feeling alienated from the GPC and BMA with fewer opportunities to become involved in creating positive impacts for the GPs of Barnsley, Doncaster, Rotherham and Sheffield.
Don’t get me wrong – there is still the opportunity to communicate regularly though round robin emails that we call “the list server” but there is no obligation for anyone to respond and when the responses do come they can often be waxing lyrical about challenges rather than creating and implementing solutions. In contrast, being face to face with the executive teams or project leads assists in encouraging accountability and outcomes.
Dr Richard Vautrey and his Executive team of Dr Farah Jameel and Dr Krishna Kasaraneni have been refreshingly open about the projects they are working on and how their negotiations with various parties are going. The chairs of the subcommittees have likewise provided timely and detailed updates of their work. We have been given opportunities as a committee to vote on aspects of negotiations and our opinions have been sought via email. There is no doubt that plenty of work is underway to help General Practice nationally and that this work is of high quality. My issue with the current form and function of GPC is with the reduced opportunity and ability to provide regional influence on national topics. After all, that is what I have been elected to do on your behalf.
I’ve highlighted to you in previous updates that the work undertaken by GPC is often confidential and by the time an embargo has been lifted on information it has usually been reported by news outlets or communicated to you via BMA newsletters. This further limits my usefulness to you as your regional representative on the GPC. Bearing in mind that many of you contribute a 6p per patient levy to fund the activities of this committee and indeed my role as regional representative, we must ensure value for money in our activities. This has led me to question how best I can serve you in this role.
What do I do for you?
As well as attending the aforementioned GPC meetings or other ad hoc meetings by invite to give a regional opinion on a national topic, I feedback at South Yorkshire LMC meetings to ensure our local medical committees are concentrating on hot topics and are informed and educated where this is needed. I attend meetings and communicate with regional leaders to influence local health and social care development where there is opportunity and flexibility to do so. As Chief Executive to Doncaster LMC I am often undertaking similar projects to colleagues in other LMCs across our region and so I share my thoughts, solutions and resources with regional LMC colleagues where this might be useful. I also write public facing articles for a number of publications with printed and online outlets reaching the population of Yorkshire.
What are the current hot topics?
It will come as no surprise to front line clinicians that the solutions contained within the GP Forward View have not so far delivered General Practice from the clutches of crisis. Thankfully, it seems this is becoming recognised in influential circles. There is work ongoing to understand and extol the strengths of the GP Partnership model whilst encouraging provision of care at scale and in cooperation with other healthcare providers. There is frantic work underway to understand the GP workforce and to try to fulfil the pledge of 5000 new GPs in primary care, but you will note that the phrase is now “5000 doctors in primary care”. This change in terminology is no accident. Given this, there remains a push towards encouraging a diverse primary care workforce that is not overly reliant on General Practitioners to deliver care but to act as consultants to the primary care team. You will no doubt have already seen discussions around direct booking for physiotherapist see-assess-treat services for musculoskeletal problems and direct booking for counsellor based see-assess-treat services for mental health problems. Many areas have also already developed or intend to develop minor illness centres that will enable simple problems to be directed away from General Practice so that Practices can concentrate on complex care that requires continuity. On top of this, there is a renewed focus on strengthening 111 and embedding this further into the primary care team.
From this, I hope you can infer that there is widespread recognition and understanding that General Practice is pushed beyond capacity and that there is a great deal of effort being made to provide solutions to increase capacity within primary care using the resources available. Of course, HM Treasury seem to think that the NHS does not need further resources whereas NHS leaders on the whole feel otherwise.
You and I both know that whatever solutions we come up with to provide care without sufficient resources and increasing challenges is always going to be a compromise. It looks like the future of General Practice is currently in the balance of gold standard aspiration versus a rusted steel affordability.