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GPs challenged by care outside of hospitals

Dr Michael Dixon, Chairman, NHS Alliance

Forward looking GP practices are planning how they can create a critical mass – via a large practice, federation or creating a social enterprise/company – that can offer an increasing number of services previously provided in hospital.

Posted: 13 September 2013

The challenge for NHS England/Monitor will be to create a climate, where GP practices and CCGs can be much more creative in devolving services outside hospital. One component of this will be measures to enable GP practices and CCGs to develop buildings and the necessary infrastructure to enable this.

PROPCO and NHS England will need to get their skates on to overcome the current total planning blight, which means that no development scheme for primary care premises has been approved by any local office of NHS England since 1st April 2013 nor, from my knowledge, have PROPCO helped any GP surgery or CCG to release buildings or land to enable this to happen. The message to PROPCO and NHS England is simple. If the paralytic hand of centralism stops local GP practices and CCGs from meeting their ambitions to develop care outside hospital then they will be the guilty people for having blocked NHS reform and the ambitions of clinical commissioners, GP practices and frontline clinicians.

Ditto incidentally for Health Education England. They must now get their act together to ensure that the Secretary of State’s ambition that 50 percent of doctors become GPs is supported and enabled to become a reality. It is totally scandalous that over the past 10 years the number of consultants has risen by 49 percent, while the number of GP Principals has fallen by 4 percent (Data for NHS health and Social Care Information Centre). So much for the rhetoric of a Primary Care led NHS over the last 10 years and no wonder there is a shortage of generalists to commission and provide for an NHS that says it wants patients to be cared for closer to home rather than inside hospital!

Yet there is plenty of hope. There are sufficient GPs and GP practices, who want to think out of the box and to develop better health and patient care for everyone on their list. GP practices that want to interface with their local communities and to help create communities that themselves can create health rather than bringing about alienation and despair. We can no longer sit on the sidelines. We must challenge and overcome those blocks for doing the right thing – whether they be in the realm of clinical commissioning or everyday general practice. In an NHS, where explicitly at least the message is about clinical leadership and an increased local voice with a primary care focus, we must now be prepared to go where no clinicians and no health services have dared to go before. To no longer ask for permission or, indeed, play by the rules. If we are truly empowered as primary care providers or as primary care commissioners, it is time to do the best for our patients and our communities and blow the rest!

Dr Michael Dixon, Chairman, NHS Alliance, and Interim President, NHS Clinical Commissioners