You’ve got to be in it to win it

You’ve got to be in it to win it

General Practice is under pressure. I have said this before, as have many others. Just within the last couple of weeks there have been news headlines criticising GP receptionists and leaked letters implying that struggling practices might be allowed to ‘wither and die’. On social media I see GPs venting their frustrations, expressing their concern about where they see things heading and clearly articulating their stress about the job they still love, and yet which is driving them to burn out. As a practising GP I see this. I see the long hours, the increased demands upon us, the lack of resource and I feel the stress. It is not difficult to see how this has arisen. General Practice has been underfunded relative to hospital care in recent years, as has Community Services and Mental Health. At the same time there has been a gradual shift of work that was traditionally undertaken in hospitals moving out into General Practice. Much of this is great for patients – closer to home and with the local GP who knows you. Unfortunately the money has not followed the patient, and GPs have added these extra bits of work to existing services, which are now straining and in danger of collapse. In addition it is widely accepted that demand continues to rise. With this as the backdrop, there are currently talks about service reconfiguration led out over larger geographies, under the remit of Sustainability and Transformation Plans. I have seen lots of GPs expressing dissatisfaction with the STP process, commenting in particular that STPs have no statutory status and no political mandate. I wouldn’t disagree.

I think there are two ways you can respond to this situation. You can be either pessimistic or opportunistic. My fear is that it is easy to be pessimistic and angry. I’m not saying that there is nothing to be pessimistic or angry about, but I would like to question if this is the right approach. 

In my experience, shouting about something doesn’t always get you the outcome you are looking for. It might make you feel better for a while, it might get someone to back off for a while, but in the long term you probably haven’t gained much. There is also the danger that you might ‘cut off your nose to spite your face’. When you are angry and pessimistic, it’s hard to lift your head up and see the opportunities. You can find yourself in a place where you can’t see the wood for the STP trees. Where are you on this?

I think we need to ensure we have the right balance. 

Is there a need to express concern and dissatisfaction, to lobby and protest against things we feel are wrong, or are being ‘done to us’? Absolutely. There are various lobby and supportive groups already in existence that I know of – Resilient GP, GP Survival, GP State of Emergency and possibly others that haven’t seen. These groups do this well. They are highlighting the problems being faced. Raising awareness amongst fellow GPs, the wider NHS and Central Government. They can do this because of their large numbers – they can get media air-time in a way an individual will struggle to do. They can also help individuals who are struggling. I see that in Facebook posts on Resilient GP in particular, with GPs asking for advice and support with difficulties they are facing, essentially crowd-sourcing solutions.

My view of these forums then, is that their existence is good, and helpful. I make a point of reading through the social media posts regularly. I have, however, become slightly concerned that they have become a place of increasing negativity. I understand why, and many I am sure would say ‘for good reason’! The problem with this, however, is as I mentioned earlier- we are in danger of missing out. More than this, we are in danger of fuelling disagreements between GPs and the organisations that seek to represent us and our views. In one recent FaceBook post I could read (in a public forum) about disagreements about whether the Royal College of General Practice was appropriate to represent our views, seemingly pitting them against the Local Medical Committees. I can’t see how this is helpful. I would suggest that both would provide excellent input, and would not wish to suggest that one was more qualified that the other – they have different and complimentary roles. 

Whether you like the existence of STPs or not, they are here, and I would suggest you disengage at your peril. A similar thing happened with the Health and Social Care Act. Lots of people were angry about this, and spent a lot of energy protesting against it. It is still here. I wonder what could have been accomplished had that energy been directed to working with the system rather than against it? 

STPs have large geographies, and it can be hard to feel part of something as large as, for example, the whole of Cheshire and Mersey (our ‘local’ STP is the 2nd largest in the country). What is becoming clear though, is that the majority ‘work’ of the STP will be delivered in local areas. For me, this means that our STP is divided into 3 Local Delivery Systems (LDS), and I am in the Cheshire and Wirral LDS which is further subdivided into 4 local integration programmes, mine being the Central Cheshire Connecting Care programme. This I now start to recognise. Within Central Cheshire we have five Care Communities, and I am sat firmly in Team Winsford. I know what’s going on in Winsford, and I know what’s going on in Connecting Care. This means that I do have a connection with the STP, and this is important. 

I have been concerned about the emphasis on acute trusts in STP planning so far. Concerned that GPs have been overlooked and disenfranchised by the process. I still have some concerns, and don’t think GPs have been properly consulted, but once I understood that our local integration programmes would be the STP plans, then I started to feel better. In fact, locally I think I can see a clear line of sight from STP to Team Winsford and our Primary Care Home. 

You have to be in it to win it, and I suspect this will be true of STPs. I suspect that if any more resources are made available to the NHS they will probably come via STPs. If we as GPs are not engaged in this, we might lose out. We can choose to shout and refuse to engage with a non-mandated process, we can be angry and protest, or we can take a moment to breathe and see what opportunities there might be here. Opportunities to do things differently- think physio first, think community matrons doing home visiting for you, think pharmacists doing your med reviews, think about making your local area an attractive place to work, somewhere you can attract GPs to. All of this could and should be part of STP planning. If we can get our community based services right, we can reduce the demand on our hospital services. This is key plank of our STP, and I’m sure will be in others.

Next time you are tempted to shout in protest about something then, my plea would be that you stop and think for a minute first. Your desire to be upset and cross may be entirely justified. What is happening may not seem fair, and may not be something you would have done or that you agree with. Nevertheless, it may be in your best interests to engage with it, and a constructive, appreciative enquiry, in my experience, can pay dividends. Like I said before…

You’ve got to be in it to win it.

Dr Jonathan is a GP at Swanlow Practice in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group

Follow him on Twitter @DrJonGriffiths