Have just returned from another holiday! Holidays are supposed to be restful but, while it was great to be out of the office, I didn't do much relaxing!
The explanation for this is that I was on a narrow boat and I appeared to be in charge of manning all locks, supplying endless cups of coffee/bacon sandwiches, etc to the skipper (husband) and walking the dog along the tow path regularly. For all that I did enjoy it!
My return to general practice set me thinking about a moment when the dog fell into the water – or rather, launched spectacularly in. Having obviously thought the bank was still there, he took a flying leap – and went straight under.
He was soon paddling furiously behind the boat until we hauled him back in. This is what I feel like a lot of the time: paddling furiously to get nowhere very fast (although I'd like to think I look more like a swan – floating serenely along, albeit paddling furiously underneath!)
I wonder if any of the new proposals in Lord Darzi's final review launched this week (30 June 2008) will make the paddling worse or better. Actually, I'm not sure they sound new. I feel as though I have heard many before. Anything sound familiar to you about the right to choose a GP, personal care plans, joined-up working across boundaries, measuring and improving quality? Oh, and locally driven, clinician-led plans?
The devil is in the detail as they say, and I'm sure it will be in the case of the "phasing out of the minimum practice income guarantee (MPIG)". Hopefully the detail will mean this is not as bad as the headline sounds. For most of us losing the MPIG – without this funding being replaced in some other way – is likely to mean a huge reduction in the quality of services to patients.
A big theme seems to be to move away from top-down target-driven measures, and replace with locally driven policies focusing on the quality of care, rather than the quantity.
If this really works I will be all for it, but I fear I have been around the NHS too long! I'm not sure that it will be able to move far enough. To me, "local" is not the strategic health authority or primary care trust, but what our patients need in our practice – which is probably different to yours.
And of course, locally led by clinicians presents its own problems – such as finding clinicians who are willing, and able, to be local leaders. I hope I'm proved wrong. What do you think?
Your comments: (Terms and conditions apply)
"I agree entirely, the Darzi report proposes a shake of GP practices. I feel that if they shake us up anymore, we will all fall out!!! Then who will provide the quality of care that we currently provide?" – Karen Saville, W Yorkshire