Dr Zoe Rog reflects on the Darzi review and looks to the future, pondering what the Government’s next move might be
Following the lack of success of the Darzi centre polyclinics 15 years ago, it was with some trepidation that I embarked on reading the recent 163 page investigation of the NHS report by Lord Darzi. I found that actually, I largely agree with most of the points made. Perhaps it wasn’t that difficult to summarise the problems with the NHS today; most of us working in it are unfortunately all too familiar with these. Though the suggestions towards solutions are fairly vague, at least now though the problems have been officially recognised.
I feel we are waiting uneasily now in the eye of the storm, waiting to see what the Government’s next move will be. The word ‘reform’ has been mentioned frequently, which conjures up the unpleasant fallout following the Lansley reforms in 2012.
However, despite my uneasiness, I find myself dreaming about the possibilities of building services around us in general practice, with which we are truly integrated. I can still remember the time at the beginning of my career when district nurses, health visitors and community psychiatric nurses were working alongside us as part of one big team. Gloriously there were no referral forms, no emails and no telephone referral lines.
Instead we spoke to one another directly, sometimes in consulting rooms, sometimes in corridors, sometimes in the coffee room. The result of this was that the care of our patients was much more seamless. We would share concerns about patients and plan their care informally, without the hurdles of bureaucracy that currently hinder the right care from reaching our patients when they most urgently need it.
Even more recently, we had a social care in practice worker who became part of our team and revolutionised social care input for many of our patients. Despite demonstrably better outcomes from this, the SCIP workers were pulled back into the central team away from us. Now we are back to being thirteenth in the telephone queue that the general public also use every time we have a patient in a social crisis.
I realise that demand has hugely increased year on year, and the estates challenge of where exactly to put all our staff so that we can work together is at odds with the black hole in the country’s finances. Creative solutions to achieve closer team working are still entirely possible though, and our GP Federations are well placed to provide these services. Our local district nursing teams and mental health teams have high staff vacancy rates in contrast to GP practices.
I strongly believe that GP Federations and PCNs can work together to improve this if they are given the opportunity. I constantly hear it said in our practice that the best thing about coming to work is our team and how supportive we are of one another in coming together to do the best for our patients. If the community staff in other teams could truly feel part of our team and part of that joint endeavour alongside us, I feel sure that recruitment, retention and most importantly, patient outcomes, would improve.
The finances must follow in a timely manner though for this to work well. The shifting of work from secondary to primary care without additional resources has pushed us to the precarious point of near collapse. Lord Darzi has observed what we already knew: general practice has the best financial discipline in the health service family. Time then to trust us with more money, and let us spend it wisely.
Dr Zoe Rog is a GP in Runcorn, Cheshire
General Practice does have the best financial discipline but PCNs and Federations do not hence this in my view is a rather confused interpretation.
It’s the same old, same old. They even want to resurrect Connecting For Heath idea, that £13 Billion shambles whose result was to fix GP clinical systems into aspic, having destroyed the competitive vibrant Medical IT industry we once had.
14 years Labour has had to think about the issues of the NHS, yet not a single new idea. There is nothing that tackles the issues which are endemic in the western word; OK, we may worst affected because we have an oldest most developed NHS. Now is the opportunity, as only Labour could possibly drive, as the midwife to the NHS, the radical changes needed, starting by defining the direction and purpose of the NHS. No vision is evident. Might was well kept the Tories in power; the NHS was untouchable for them too.