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CCG Series: Where does it hurt Doctor?


11 July 2013

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It feels like the world conspires sometimes to make things difficult for CCG clinical leadership.  We work in two worlds as frontline GPs and commissioners of NHS services. Unlike other organisation our senior team have to walk the walk as well as talk the talk. Making promises we then have to live by and deliver is a huge personal challenge for us all.  I ponder how often Richard Branson worked the tills in a Virgin store.

It feels like the world conspires sometimes to make things difficult for CCG clinical leadership.  We work in two worlds as frontline GPs and commissioners of NHS services. Unlike other organisation our senior team have to walk the walk as well as talk the talk. Making promises we then have to live by and deliver is a huge personal challenge for us all.  I ponder how often Richard Branson worked the tills in a Virgin store.
The above would be enough of a challenge but to heap joy upon joy we are all, as GPs, under a daily assault of specious rhetoric from various sources who should know better.  There are also rising demands; greater patient expectations, regulatory burden and diminishing primary care investment.
Primary care is the foundation, upon which the NHS stands or subsides.  Delloite’s recent report states that 90% of consultations in the NHS occur in primary care (about 80% GP).  This is all primary care dental and optometry included.
Resourcing of primary care and community services has not changed proportionately over the past 10 years.  So collectively our current systems and strategies are failing to deliver the sustainable future for the NHS described in the Wanless Report.  The paradigm of acute focussed intervention for those who have become ill persists.
How can we do things differently?  There are some inescapable truths which need to be accounted for in any potential solution.  Qualified GP numbers per ten thousand population are now largely the same as they where 10 years ago, with increasing numbers of consultations per registered patient over the same time.  If these pressures are to be addressed in Warrington we need to know our starting point. This context is the backdrop to our local workforce survey which gathered responses via a web survey and was collated within the CCG.
The survey revealed a GP workforce who's job satisfaction is at an all time low, 50% of our GP members surveyed self assessed themselves as very unhappy or unhappy with their current role. We are struggling with the conflicting demands of our professionalism and changing patient/NHS expectations. 
Those surveyed also reported rising activity with increasing complexity yet conversely a lot of activity presenting to GPs which could be managed differently.
Where does it hurt?  I think our member practices have said, “it hurts all over.”
 
If thats the problem … what's the remedy?
It would be easy to be negative and throw in the towel faced with the kind of pressures we all deal with each day.  It is absolutely taking its toll certainly on the workforce in Warrington.  But despite all of that the people I work with and on behalf of are finding solutions.  As a CCG we are embarking upon a phase of development to systematically address the issues raised.
We have arrived at 10 themes for our work in primary care development:
  • Access, Demand and Capacity
  • Medicines management and prescribing
  • Nursing and Residential Homes
  • Primary Care Quality – What is the ‘Warrington offer’
  • Whole system/right care – what is the role of Primary Care in effective utilisation of the whole system resource through system integration
  • Complex care including long term conditions
  • Prevention and self-care in Primary Care
  • Mental Health
  • Workforce
  • Public engagement and communications in primary care
Our primary care development strategy has been agreed with our area team commissioners.  To develop solutions within the above strategic themes I have established a development group consisting of our quality lead GPs, non principal GP, practice nurse and practice manager with support from a dedicated CCG management resource.
To prepare the way for some of the changes we will need to make 10 practices covering over 100,000 of out 208,000 population have embarked upon the NHSI productive general practice program as a CCG funded initiative.  It will be hard work but worthwhile.
Will it work?  I honestly don't have the answer to that question … yet.  But continuing along the same path we have been on as GP's will not make things improve.  Worsening the situation for our patients and for our own wellbeing, happiness and personal capability.  The approach used in commissioning for improvement with other providers in our local health economy we are now turning towards primary care.  There have been some positive changes already, in the form of our primary care urgent care unit, which has started to shift our non elective admission rates and helped maintain access targets in AED both against national trends.  To be fair though locally our non elective rates have always been higher than average.
Those facts give me hope that through working in partnership across our health economy we can affect real change, and deal with some of the wicked issues which have seemed so insoluble.
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