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Secret Diary of a PM – What will 2019 bring for Primary Care?

Every January I have written a review of the previous year in general practice and discussed my hopes for the coming year. Reflecting on what I normally write, I want to be a little more optimistic about 2019.

In 2018 I saw the best of the NHS at first hand. My family and I were treated as patients, and in all but one case the care and attention received has been wonderful.

Spending a night in A&E I could see the real pressures on the system, but also how nurses and doctors maintained a high level of care and remained kind and professional at all times.


A year of extensive change

2018 was a year that a lot changed in the NHS, with a change of Health Secretary from Jeremy Hunt after six years to Matt Hancock. I can remember writing at the time, “be careful what you wish for” and nothing I have seen in the last few months has led me to alter my opinion.

We already know that the new health secretary is a great fan of GP@Hand, which leads me to think that this is the way he may want to take the NHS - a two-tier system, one that is cherry-picked by providers that do not want to deal with long-term conditions, with the rest of us left to pick up the pieces.

Whilst many will like the instant mobile consultations, many will not - and if patients develop long-term conditions, are they going to be asked to sign on elsewhere? Looks to me like a case of profits first, care second.


Common sense gets the cold shoulder

We also saw dithering by NHS England on which flu vaccinations they were going to recommend. When they did finally decide in February, it was for two different vaccinations - one for over 65s and one for under 65s.

Logistically this was very tricky for surgeries in ensuring the right person got the right jab and this was not helped when deliveries of the new vaccine for over 65s were delayed and rationed. This led to a lower uptake nationally and affected the very people we were trying to protect.

In 2019 there is talk of yet more change around flu vaccines and again the advice and details are very sketchy. There is possibly going to be a third option of a new vaccine that will cover everybody, but from another new manufacturer.

Are they going to cope with the demand from a start-up base? At our practice we are thinking of hedging our bets and replicating what we went with in 2018.


A very happy birthday?

2018 also saw the 70th anniversary of the NHS and I felt the celebrations were very low key. This was an opportunity to talk about all the good things the NHS stand for and put into perspective the problems we know exist. Who would have thought 70 years ago that the NHS would be delivering the range of care it provides now?

Demand on the NHS in 2018 has not let up and in many parts of the country it has remained at winter levels throughout the whole of 2018.

GDPR presented us with yet more issues leading up to its implementation in May 2018 and even now we are not much wiser in some respects. We had a possible breach by a nursing home and when we spoke to them, they had no idea what GDPR was! In fairness we have had only a handful of Subject Access Requests for medical records from patients, but have heard of surgeries being inundated.


What about 2019 for Primary Care?

Turning to 2019 there seems to be a will by the government to pour more money into the NHS but I do question the amount of it being put into IT.

In my view, this is to the detriment of patient care - so much is being offered to surgeries, such as the digitalisation of notes, heavily subsidised new telephone systems, and health monitors for the waiting rooms etc, when we are all independent businesses and feel some of these costs are borne by the surgery. However, we will not be turning the money away.

2019 will also see further discussions around the merging of CCGs and again I wonder how much money is being spent on this. All the uncertainty is leading to many valued staff in our CCG leaving and their knowledge will be lost.


Spotlight on pension contributions

As I write this, I note there is a consultation going on about increasing employers pension contributions up to 20.6% from April 1st. This seems to have been announced right over the Christmas period - trying to bury bad news?

The consultation ends the 29th January 2019 and I encourage you all to have your say. Reading through the proposal it does imply that surgeries could be reimbursed in some way. Take a look by clicking here.

It seems like utter stupidity, just like when CQC fees were hiked up but it was CCGs who paid for it. Where they get their ideas from I have no idea, but again this is a scheme that will hopefully be cost-neutral to surgeries.


The elephant in the room

I cannot leave out Brexit. Whilst it raises issues of staffing, I also have patients and friends repeatedly asking about ongoing supplies of their medication and whether they will be guaranteed in this or that scenario. We are not being told, other than there should be stock of medicines for up to six weeks.

This is not great and patients I know are trying to stockpile - who can blame them?

Don’t forget to let us know your thoughts about what the 12 months ahead hold in store for General Practice and the NHS in the comment section below.


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