From treatment to prevention - The first Priority

The first of Buckinghamshire's priorities is to "Shift the focus of care from treatment to prevention".

The Clinical Commissioning Group has describes this as:

"Each and every clinical contact to include brief advice, supported by face to face, phone and web based behaviour change support. Build on existing asset based approaches."

What I think it means:

Everytime you see a Doctor, Nurse or other healthcare professional you will be told to eat sensibly (less?), take more exercise, drink less and to stop smoking. You will be encouraged to use an App or website to help us change our behaviour.

Hopefully they will even support patient led groups & community groups to do the same.  I asume these are what they mean by "asset based approaches" i.e using people to reinforce their messages.

This seems a good idea but it will take a long time before any improvements are detected. The Public Health departments in the County Council should be funded properly to support this work. Will the council do that?

I am not sure that busy Doctors and nurses will find the time in our appointments to keep nagging us.

Possible models of General Practice

Any number of organisations have looked at the possible models of General Practice in England (see below for some recent examples).  They have produced lots of glossy pages describing the issues and possible models.

So we thought we would produce a short list of the possible ways that a local community could get its GP service provided. In no particular order.

“The Status Quo”.  The partnership option.

Under the current circumstances, unless the government changes its attitude this is not a realistic option.

A Salaried service with GPs.

a)    Through Foundation Trust Hospital – Vertical integration.

b)    Through private companies i) groups of GPs, ii) multi-national companies iii) venture Funds etc.

A nurse led service

This would probably be with GPs as community specialists/consultants at a distance. (There would be no doctor as first point of contact, no legal right to a GP).

Walk In centres.

Patients would be triaged and referred onto the ‘appropriate’ Healthcare provider.

NHS111

All access to healthcare would be through NHS111 call centres

Federation

GP practices merge or federate to form a large organisation (Management & Admin merged to save money & probably staff used across all sites rather than based on a specific site).

Investment by Government

You never know it might happen. The government realises that the current system is the envy of the world and invests to support the development and innovation that has taken place over the last 30 years

I may look at the advantages and disadvantages of these options at a future date.

 Further reading

Nuffield Trust

http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130718_securing_the_future_revised.pdf

RCGP

http://www.rcgp.org.uk/campaign-home/~/media/Files/Policy/A-Z-policy/The-2022-GP-A-Vision-for-General-Practice-in-the-Future-NHS.ashx

Kings Fund

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/commissioning-and-funding-general-practice-kingsfund-feb14.pdf

NHS England A call to action

http://www.england.nhs.uk/wp-content/uploads/2014/03/emerging-findings-rep.pdf

Great idea - shame about the implementation

There is this great idea.  There is a sum of money available.

Everything is set up, application form printed, lots of publicity. GP surgeries informed of the scheme by email.

The scheme went live - patients and carers informed.

All they had to do was get a signature from a GP.  Oh so simple!

There was lots of interest and so lots of visits to GPs.

Suddenly a problem emerged.  The GPs knew nothing about the scheme.

The first they knew about it was appointments being filled to get the signature. Now we all know how hard it is to get an appointment with a GP. So any appointments being used up in this way, just for a signature was not good news.

There was another problem. Carers were turning up asking for the signature on their own. There were confidentiality issues as the patient was not there to give consent.

All in all a most unsatisfactory situation and the GPs got a bit fed up with it.

So why did it come to this?

Sadly it was the result of not doing things properly.  The Primary Care Trust should have involved the GPs at an early stage in the design of this scheme. They did not!

Result: a good scheme that would benefit those hard pressed carers is delayed.  There are irritated GPs, carers and the other people involved in the scheme.

All the evidence shows that when designing a new patient pathway, a new service or a new scheme of some sort you should involve everyone in the design of the scheme at an early stage in the process.

You also need to develop the implementation of the scheme at the same time as designing the scheme itself.

Typically redesign happens, then they think about talking to the patients and other stakeholders. Its too late then.  Involve them early often and in a meaningful way!

So what is happening? Hopefully they will talk to the GPs, sort out the form, sort out issues of confidentiality and then maybe, carers can get the breaks they deserve.

Cock -up or conspiracy

Why?

Why have I called my blog "A stone in the shoe"?

You know what it feels like when you have a stone in your shoe? Every step you take it irritates, you can feel it, it niggles! You try to wriggle your foot and hope it moves to somewhere else in your shoe.  Then you try kicking your feet in an attempt to move it.

Finally you have to stop, take off the shoe and give it a good shake .

Even then once you put the shoe back on you find the bit of grit is stilll there.  Or is it another piece?

Off with the shoe
Off with the sock
shake it all about

Put them all on again and suddenly you are comfortable.  Walking is a pleasure again.

Well.

That is what I feel I am to the local health authorities. An irritant, a stone in the shoe that just will not go away.

I want them to remember that there are patients involved in the 'businesses' that they run.

I want them to remember that they need to provide evidence that the changes they implement will benefit patients (and staff).

I want them to remember to manage change properly.

I want them to design and redesign patients pathways involving patients (and staff) early and often in the process.

I want them to build the process of implementing the new designs into the design process, not tack it on afterwards.

I just want them to do things properly.

So I ask questions at board meetings and Council Health Overview and Scrutiny committee meeetings.

I persist until I get an answer that members of the public can understand AND that answers the question.

Its not easy.

So I try to be that stone.  Always there.  A reminder to do things properly, in an evidence based way, using language that people can understand.