Our GPs came first nationally for overall patient satisfaction this week in the most recent national survey. That is a fantastic achievement. 93% of patients rated the service as good. Does that mean that things are easy in general practice here? No. Talking to the practices I know they are working really hard and struggling to meet the demand they face. They need though to be congratulated for the effort they put in to maintain such good services despite the pressures. It is an even greater achievement at a time of such pressure in the system.
General practice is under pressure as never before. A perfect storm seems imminent. The age profile of GPs in our area (and reflected nationally) points to a mass exodus over the next 5 years, exacerbated by pension changes, revalidation demands and general change and workload fatigue. At the same time applications for vocational training are at an all-time low. Our local VTS which normally has no problems recruiting has less than 25% of its usual numbers this year. They can survive one year like that but another year would mean serious problems for the area and the hospitals the training posts support. Practices are struggling to recruit. I am reliably informed the average age for a female GP to leave the services is 36! Mainly because they leave to have children and then don’t return, choosing other specialities over general practice. WE have to do something urgently to make general practice a more attractive place to work. At the same time demand is spirally upwards.
We will also have a real deficit in GP leadership. CCGs are predicated on clinical leadership from the GP community but we also now need leaders to develop and change general practice as a provider of health care, leading federations of primary care, looking to new models that both secure what is best about primary care whilst responding to the challenges of a changing work force and service demand.
And there really is some urgency about finding solutions. Poor primary care will lead inevitably to increased demand on hospital services.
I have been out of clinical practice for just over a year. I returned recently to my old practice for a meeting. AS I walked across the threshold I was struck by the return of what I can only describe as “ a tension in my gut” and I recognised that feeling as something was there every day at work but had never consciously felt it. I only was able to recognise it in retrospect. Looking back I can see it was all about managing the unpredictability of the day and making decisions big and small.. all day.. managing risk… all day every day… I did it for 25 years and loved it but it is a tough job. And it is getting tougher. The role of the gatekeeper to the service is underplayed but it is a vital part of our system.
As a profession though, we must resist the impulse to push patients away as a response to overwork and the pressure. I phoned my Mums GP practice this week and asked for someone to visit her. No panic. Not urgent but she is too confused now to visit the practice. It would be too frightening for her. We had received a letter telling us who her “named GP” was. I was relieved. At 94 and having been at the practice for 10 years she is still only ever seen in one off episodes. When I requested that the named GP visit her… I was told promptly that the service “doesn’t work like that” and anyway “it was just a government paper exercise”. If we are going to campaign about poor funding and workload pressure surely GPs must still occupy the moral high ground and do our best for our most vulnerable patients. We must remain the advocate for patients . When I told my story many people responded they too had found themselves “fighting” to get in through the primary care front door. This wasn’t good enough for me, for my Mum. I made a fuss and in the end she was visited but it shouldn’t be because of who I am. It should be there as a right for everyone.
What can CCGs do? Well we have commissioning an “out of hospital scheme” this year… rolling up our local enhanced services monies and adding some more to move services AND the funding out of hospital and into practices. We supported our GPs to successfully bid for the Prime Ministers Challenge fund, and we are working with our local VTS to develop services in our local DGH that will make coming to our area as a trainee more attractive, and develop roles for trainees within the CCG. WE are also doing our best to develop and support any GPs who demonstrate interest in leadership, by offering bespoke roles and leadership skills training. We have expressed an interest in gently becoming involved in co-commissioning but we anticipate the issues will be complex and are concerned about a general lack of capacity either within area teams or at CCG level. It is a complex agenda and needs good people to invest time and energy into getting it right.
It isn’t enough. Some of the solutions need national action…the first step is for everyone to acknowledge the size of the issue we face and to understand what is driving people away from primary care and into other career choices. Of course waning interest in primary care as a career has happened before and the profession has survived but the issues around retirement weren’t there then, GPs were staying on into their 60s.. they aren’t now so unless we address the issues we will fall down a hole and such high levels of user satisfaction in primary care everywhere, but particularly in our area will be a fading memory….
Thursday 17 July 2014
Tuesday 8 July 2014
Hard work should be fun!
It is a while since I have written my blog…. I guess life got in the way.. two of my daughter had babies so I have been juggling work with grandparent fun stuff and some things have to slip… anyway.. as I have driven round the country I had had many potential blogs running around my brain..
Every day as I listen to Radio 4 Today programme on my way to work I hear the endless drip of negative NHS stories, we seem as a nation intent on always believing the worst. It makes me sad. For those of us working in the service working really hard to make it better but believing we already deliver a service that is good for most, excellent for some but we know it is poor for some too .. and no room for complacency and so many challenges ahead. But all the negative makes it hard to feel good about what we do every day when we come to work. It weighs you down. My daughters had a patchwork of experiences.. some good.. some excellent some only average.. mostly dependant on the individuals they came across. So much of what influences patient experience is the attitude of the individuals who deliver the service..and what mattered to them was being involved in decisions, treated like a person not a walking womb, given time, looked at and acknowledged. Simple stuff. But that simple stuff happens when the organisation allows individuals who work there to flourish and enjoy their work. To feel valued and important. When you feel valued it is easy to help others to feel like that too. It is infectious!
At a time of such threat and challenge in the system it is more important than it ever has been that those who work in the NHS feels valued and can feel good about coming to work. WE talk about fun. Is it fun to be at work? If I hear laughter in my organisation I feel we are on track. Yes we are busy and we do a lot every day.. but we can also be relaxed enough with each other to laugh at lunch times, which we have together in the kitchen and even at the meetings where important work is done too.
We have developed a game to play with our stakeholders and the public called “Strictly Come Commissioning”. It is a board game played by a group of people playing at being commissioners for a day We piloted it our recent Health Watch conference and it went really well. It stimulated lots of conversation and debate about all sorts of issues. There was a real buzz in the room. Should we commission services for people who smoke/are overweight/ subfertile? How do those services stack up against services for people with cancer or autism? What do you do when urgent admissions spiral out of control? We did get a letter for someone who got the invite but didn’t attend saying we shouldn’t be playing a game about serious things.. but we learn through play and it was fun. Is that wrong? When did work become something that had to be serious all the time? Surely that isn’t a natural way to be? We are now thinking we could use the game to explain commissioning to all sorts of groups: GP trainee doctors, A level students, patient groups, surely better than me standing there with a powerpoint?
So whilst we are all working so hard changing so much, working under such pressure, lets remember also to have moments of lightness and fun too. It helps teams to value each other and work better together and it doesn’t reflect any lack of commitment to the job. I read somewhere that adults laugh an average of 9 times a day compared to children who laugh 40-50 times a day. So here’s to hard work and laughter.
Every day as I listen to Radio 4 Today programme on my way to work I hear the endless drip of negative NHS stories, we seem as a nation intent on always believing the worst. It makes me sad. For those of us working in the service working really hard to make it better but believing we already deliver a service that is good for most, excellent for some but we know it is poor for some too .. and no room for complacency and so many challenges ahead. But all the negative makes it hard to feel good about what we do every day when we come to work. It weighs you down. My daughters had a patchwork of experiences.. some good.. some excellent some only average.. mostly dependant on the individuals they came across. So much of what influences patient experience is the attitude of the individuals who deliver the service..and what mattered to them was being involved in decisions, treated like a person not a walking womb, given time, looked at and acknowledged. Simple stuff. But that simple stuff happens when the organisation allows individuals who work there to flourish and enjoy their work. To feel valued and important. When you feel valued it is easy to help others to feel like that too. It is infectious!
At a time of such threat and challenge in the system it is more important than it ever has been that those who work in the NHS feels valued and can feel good about coming to work. WE talk about fun. Is it fun to be at work? If I hear laughter in my organisation I feel we are on track. Yes we are busy and we do a lot every day.. but we can also be relaxed enough with each other to laugh at lunch times, which we have together in the kitchen and even at the meetings where important work is done too.
We have developed a game to play with our stakeholders and the public called “Strictly Come Commissioning”. It is a board game played by a group of people playing at being commissioners for a day We piloted it our recent Health Watch conference and it went really well. It stimulated lots of conversation and debate about all sorts of issues. There was a real buzz in the room. Should we commission services for people who smoke/are overweight/ subfertile? How do those services stack up against services for people with cancer or autism? What do you do when urgent admissions spiral out of control? We did get a letter for someone who got the invite but didn’t attend saying we shouldn’t be playing a game about serious things.. but we learn through play and it was fun. Is that wrong? When did work become something that had to be serious all the time? Surely that isn’t a natural way to be? We are now thinking we could use the game to explain commissioning to all sorts of groups: GP trainee doctors, A level students, patient groups, surely better than me standing there with a powerpoint?
So whilst we are all working so hard changing so much, working under such pressure, lets remember also to have moments of lightness and fun too. It helps teams to value each other and work better together and it doesn’t reflect any lack of commitment to the job. I read somewhere that adults laugh an average of 9 times a day compared to children who laugh 40-50 times a day. So here’s to hard work and laughter.
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