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Thursday 29 September 2016
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Growing pains

Insight: commissioning

Anil Mehta

Clinical Director
Fairlop Polysystem, NHS Redbridge

GPs are a lucky bunch in many ways enjoying widespread respect and trust among the community. They rarely come into contact with the Press and on the rare poccasions they do often receive a sympathetic hearing.

However, this traditionally media-shy group are about to be thrust into the spotlight as primary care's new decision-makers.

To date, that role has been filled by the country's 152 primary care trusts but their demise and replacement with all powerful GP consortia will shift the weight of responsibility onto clinicians' shoulders along with the accompanying media attention.

Even the greatest optimist would be hard pressed to believe that tough decisions around service provision aren't on the horizon, especially in light of the government crusade against debt reduction.

There is also sensitivity around what some see as the first steps towards privatisation of the NHS.

Supporters of the government's white paper on health decry such claims are alarmist, while its critics say the public is a sleeping giant yet to be awakened to the implications.

What we do know is that the NHS is as British as tea and rainy summers and its marriage to the national psyche both deep rooted and instinctive.

The heart is likely to rule the head when it comes to public support of the NHS and that could mean a rude awakening for its current masters without a clear communications strategy.
GPs are caught in the middle of this and while many have lobbied for greater decision making powers they are also wrestling with the logistics of such a transfer.

The consulting room is suddenly looking very small and the media is beginning to bang on its walls in search of answers to Health Minister Andrew Lansley's vision of the future.

The pace and scale of change are certainly unprecedented in the NHS's 63 year history and people are only now starting realise its implications.

NHS Redbridge in north east London has had GPs at the helm for the past year having already transferred 80% of its annual £400 million budget into their hands.

Dr Anil Mehta is one of five clinical directors responsible for overseeing the new GP-led services in Redbridge.

He recognises the leap of faith clinicians are being told to make and has flung himself into media interviews with a gusto that reflects his expanded role.

Anil said: "We've been running most of the primary care services in Redbridge for the past year and I have already been interviewed by a number of publications.

"I enjoy the challenge of getting our message across.  It is important to let people know what's going on and the fact that we want to make real improvements to services.

"No one is denying there is a huge amount of duplication and wastage in the NHS but the beauty is that there are various improvements we can introduce that will save money and lead to a better service for patients.

"This is the start of a new journey for the NHS and we want to make sure the public are sitting beside us."

However many GPs across the country will have doubts. Doctors enjoy an enviable position of goodwill in the community which could be overshadowed by them holding the purse-strings and the difficult decisions that involves.

The shock of seeing your words in print for the first time can also come as a surprise as one of Anil's fellow practitioners discovered when they were wrongly linked to a story about proposals to relocate the borough's only A&E department.

The GP in question not only had to contend with the local newspaper ringing the surgery for a comment but also an irate politician on the warpath for being publically challenged over some disputed figures.

Anil remains pragmatic about the media relationship.
"It would naïve to think it's going to all sunshine and blue skies, especially as north east London is the first area of the capital to face major service reconfiguration.

"However, I'm an optimist and, as long as I believe the worth of something I have no problem putting our side of the story across."

Anil is first to admit that newspapers, radio and TV regard Redbridge as something of a curiosity since they are one of first areas in the UK to come under scrutiny with regards to GP commissioning.

So how does he find his new role as a local spokesperson on health?

"I'm quite enjoying it although I haven't been on the receiving end of any criticism yet beyond some colleagues joking about seeing my picture in the papers.

"I've been dealing with the local and national trade press recently who are curious about what is happening because Redbridge is ahead of the game. People want to learn and I'm delighted to share that expertise.

"The government has highlighted the need for an 'information explosion' and I agree that informing and educating people and more effective signposting is a major area we need to work on.

"GPs are good communicators on a one-to-one basis but we have to learn to effectively communicate to a wider audience and the government have made it clear that greater public involvement is a condition, not an option.

"There are some huge issues that the public have to understand and act upon such as more appropriate use of services like A&E.

"It's no good just blaming the organisation. The NHS is the public and vice versa and that calls for shared ownership and better understanding about what each and everyone of us can do to make it more sustainable."

He highlights the fact that a sizable number of A&E attendances would be better treated at urgent care centres together with the fact that surgeries are charged £80 for every patient who attends A&E – a collective cost of £1.25m a year across north east London.

Anil added: "We also have to affect a sea change in personal responsibility for health, exercise and diet. People might not like hearing it but one of the biggest drains on NHS resources is treating diseases and illness that are indirectly caused by unhealthy life styles.

"If we find the key to unlock that problem and make it sustainable that would be a revolutionary turning point in health care. That's our golden egg and we need to get busy trying to crack it."