Management in Practice
The exceptionally heavy snow back in February may have been a sign that 2009 was going to be tough. As schools and offices closed to allow for the construction of snowmen, practice teams remained heroically open. Writing to MiP online, Louise Bzdek from Slough was "very disappointed in how the country deals with adverse weather … all my admin team made it in, and I walked to the surgery – taking 50 minutes in 5 inches of snow."
Things heated up in the summer when shadow health secretary Andrew Lansley's call for practice boundaries to be scrapped drew angry fire from managers. "Totally impractical", said one member of the MiP online community; "How would we function when a home visit is needed?" said another, and "What planet does this guy live on?" said someone else, more bluntly.
The government had clearly listened to its general practice professionals and taken their views onboard. Or perhaps not. A few months later, Andy Burnham, who became the new health secretary in June, said that he could "see no reason why patients should not be able to choose the GP they want" and announced that practice boundaries would indeed be axed. So there you go.
With the lines literally redrawn, general practice will become more competitive as surgeries try and attract the most patients. In October, the NHS Choices website started to allow patients to rate their practice, something of a double-edged sword for managers: while it represents a new marketing opportunity, it has also led to fears that a disgruntled minority of patients could leave unreasonable – and unrepresentative – reviews. Whatever the outcome, it appears that promoting your practice will be a bigger concern next year.
Then there were the GP Patient Survey results in June. Despite overwhelmingly positive results (91% of patients in England were satisfied with the GP care they received) the Department of Health managed to snatch defeat from the jaws of victory, as many practices lost thousands of pounds of funding in relation to two QOF indicators. The British Medical Association lambasted the survey as "rubbish", claiming questions were flawed and responses were misleading. The episode marked another downward turn for the relationship between government and general practice.
It's not just patients you'll need to worry about. The Care Quality Commission is limbering up to regulate all practices in 2012, who will need to show they meet 16 essential standards of quality and safety. And in April, an 18-month inquiry into the quality of GP services was launched by the King's Fund. A report is expected in September 2010.
Such is the need to find solutions for the cash-strapped health service that, in July, the Social Market Foundation even suggested patients should be charged up to £20 to see their GP. This met with mixed views on the MiP site, but a greater financial strain will no doubt be felt in GP-land next year.
I haven't even got round to swine flu yet … of course, so much more has occurred this year, but for the purposes of space and wishing to end on a cheerful note, much better to wish you a Happy Christmas and the very best for 2010!