Mword - Issue 30

12 September 2016

Dear Colleague,

Yesterday's statement by the Chief Exec of NHS Providers (that's hospitals to you and me) has at last made visible to the public and the media what we all have known and been saying for months if not longer. And it applies as much to ourselves in general practice as it does to them. It is against this backdrop that we must see the current round of NHS change or 'transformation' which includes:

• The NHSE FYFV (Five Year Forward View - Oct 2014 so we're now two years into the 5) - 'new models of care' and "voluntary" contracts and such like. Also promised 'stabilisation of general practice within two years' - 'nuff said.
• The NHSE GPFV (GP Forward View - Feb 2016) - the inadequate so-called 'rescue-package' for general practice worth all of 25p-50p per patient and only if - and it's a big if - we can get Harry Potter to summon up the Alohomora charm (look it up) and then elicit the Heineken effect to get the cash to where it needs to reach.
• And now, STPs (sustainability and transformation plans - the clue is in the title) which for the last few weeks have been referred to by NHSE as "footprints" of which there are five being created across the old Strategic Health Authority areas or 'sectors' of London . Remember those? (More below on STPs.)

So as if we GPs and our teams haven't had enough to contend with, we now are blessed with another new wave of planning, this time putting the inadequate buckets of health and care together, spreading them over seven days instead of five, and expecting those of us at the frontline - well before any non- emergency patient should even need to get near a hospital, to somehow absorb all the load, the demand, and risk as if we created this problem. Well let's be clear, we didn't.

• It's not GPs who have been saying the best way to run a health service is to allocate only 8% of the budget to general practice (or nearer 7%, depending on who you trust!).
• It's not GPs who have been saying strip out our health visitors, put district nurses on a caseload treadmill so stretched that they too cannot be retained. Ditto social, mental health and other community workers and stretching voluntary and charitable services beyond their capacity.
• It's not GPs who have been saying disinvest in our workforce, premises and the services (community, mental and social) we need around us do our jobs effectively to direct patient care to where they need to access it and not to where the money flows under the discredited payment by results system ie keeping patients away from hospitals they wouldn't need to attend if those services around us were properly and adequately financed.

It is not GPs who have created this mess. And actually it isn't patients either.

There. Said it. So now what?

Well I still believe general practice has the key - even though we have had the stuffing taken out of us. Perhaps it's drawn from personal resilience. Or perhaps it's the meds.

Either way, I'm not prepared to let them destroy what I believe in and what I remain pretty convinced you believe in too - the values that we as GPs and our teams hold.

Which means I believe we have to survive this current chaos with even more determination than all the other waves of chaos. So if transform we must, then let us not do it at the expense of our values, or compassion for ourselves. Let it be a transformation in our own image and not the image of those who this far still just. don't. get. it.

And to help us do that I will be issuing a fair few more of these MWord things over the next few weeks. And with that let me take you back to those STPs. Well SURPRISE!!!! Here's Michelle's Prediction: each STP along with their constituent CCGs, will very shortly be operating as one entity, returning us to 5 planning bodies for London, albeit this time with closer alignment to local authorities. Who knew?! So as an MWord starter for ten, take a look at the STP Q&A and see if you can work out why we so need to be representing you like never before in this new London world of transformation, devolution and survival. And with MPs due to debate STPs in Parliament this Wednesday, read my letter to them here.

Best wishes,

Michelle
Chief Executive, Londonwide LMCs

As ever - Please do let me have any views on these issues or others at mword@lmc.org.uk.