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Secret Diary - a 'Panoramic' view of life in a GP Practice...

Did you watch the recent Panorama expose on a group of NHS practices, which were being run differently to the norm? It has been perceived in different ways by different people and has set me thinking in general terms about primary care.

So, an undercover reporter got a job as a receptionist in a practice belonging to a large group of over 70 practices, and over 600,000 patients. owned by a large US-based medical company. The group was using a mix of clinical staff which favoured the use of more physician associates and nurses and locum doctors, and less with salaried doctors on site.

At times we could see they had no doctors’ appointments on certain days and the working model did not support the staff in place, or the patients. The patients were frustrated at the lack of care and access, and those interviewed (who we can assume are staff working at this practice) were unhappy with the setup.

Some people I have spoken to felt this was an attack on physician associates and nurses in general, whereas others felt (as I did) that it was more an attack on the working model of this group of practices, who were allegedly choosing to use cheaper clinical staff to make more money.

We were warned before the airing of the documentary that it could cause patients to refuse to see a physician associate, we were prepared the next day for any fallout.

Thankfully, we found did not happen, and we had no change in patients agreeing to see a PA, which is probably because, like most of us, we use the new positions to complement our clinical access, not to replace them.

We have full support measures in place to monitor and support these staff with exactly what they need, and the feedback we get from our patients and staff is very positive. They will never replace GPs (and there will be no intention to do so), but physician associates are part of an ever-changing team that is fit for the demands of the 21st century patient.

Some of the matters being presented in the programme did give me cause for concern for the care and service given to their patients (some of whom said they had not been able to get an appointment for six months?), but it also left me thinking…

Has CQC been inspecting this group? And if so - what were the outcomes?

If they haven’t – will they?

Privatisation

Another thought has struck me about the continual threat of NHS privatisation. I would say that primary care is already based on the private model – after all, we are all independent private businesses working under contract to the NHS, and we survive or fall on how we run and perform.

From my point of view, it is the private model above that does not appear to be regulated as it should be.

Should we be worried? I think so, as the majority of practices work very differently to the model exposed, and for a corporate entity to take on primary care services as they would treat a factory or string of shops just does not really compute – we don’t dish out sweets and biscuits, we’re saving and improving lives. Going for the second cheapest option shouldn’t be the standard operating procedure when it comes to dealing with patient – or staff - safety.

The Fuller report

In a recent report, there is a suggestion that GP partnerships should be phased out in the next 10 years and that primary care would be run by salaried GPs only. I read that as basically nationalising Primary care.

This has raised concerns, but I wonder what the chances of this really happening. Current partnerships have invested heavily in their practices with buildings and the offering of many different services.

Can anyone really see the NHS buying up property belonging to partnerships at the market value? I certainly cannot see this happening and partnerships are more likely to sell or redevelop their sites and leave the NHS. The current comments that the NHS as a whole has never been as well funded is another red herring to me. We all see that it is the waste within the service that needs to be controlled.

Just mention the PPE fiasco and that Capita has been given an extension to their contract despite its poor running and lack of any accountability. The wastage of Covid vaccines as the setup was ill-thought-out and was based on theory which is not the way things really work out and so on.

And finally...

As I write this, I’ve just seen that EMIS is being sold to an American conglomerate. I can only hope that they can get to grips with the continual slow running of the system and the problems we face on a daily basis and that they will improve the functionality and make the system fit for purpose.

Want to share your experience of practice management or have a story to tell in our (anonymous) Secret Diary? Just email us at mail@firstpracticemanagement.co.uk


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