Using questions submitted via Practice Managers on our forum, Practice Index talks to the Institute of Healthcare Management (IHM) about the pressures on primary care, future changes, integrated health set-ups and much more.
What should the new government do to make entering general practice more enticing for doctors?
The biggest issue in general practice is workload – not only for the GPs but also for the staff working alongside them, such as the practice managers. Burn-out is common, which is reflected in the number of GPs opting to take early retirement or move to new shores.
Moving to models where work done is work paid for would certainly help manage this risk. A two-session day commonly melts into 12 hours or more of work, with no incentive or resource whatsoever to fuel this extra work. It is not going to be possible to maintain a high standard of primary care based on the personal energy and goodwill of doctors and their staff. A tangible investment in this sector, along with a protection of the hours worked, would act as a huge incentive.
What major changes do you predict the government will make to the primary care sector?
The government has made its direction clear: the vision is to move to seven-day working and greater integration of services. The challenge for general practice is to streamline models of access to offer better and more access on equal or less resource. This is a daunting prospect, but not outside the realms of possibility using models of same day access through 100% clinical triage.
Ensuring scaling of services and a widening of the middle sector of the workforce will help practices keep up from a resource perspective within a changing landscape. This will take strong, lean managers who are able to articulate a new vision around the identity of what we understand to be general practice.
Transparency will be key. Core values must be promoted and protected, while those areas that are open to negotiation are clearly identified and explored.
Do you think we will see the much talked about integrated health system any time soon and what could it mean for GP practices?
There is a genuine commitment to make this finally happen, so IHM expects to see significant movement in this area, translated into more management of urgent demand within primary care, and greater cooperation between primary and community care services.
Upscaling of delivery models will need to take into consideration data sharing, premises and co-location models, with primary care driving the integration between various providers of services, whilst thinking of how to increase its capacity to manage urgent presentations of care, and increasing the availability of diagnostics. This is an exciting development for both patients and those working in primary care, as new models of working will create the opportunity for the development of new services. This in turn should impact positively on the financial sustainability of general practice.
Would a cross-party think tank with medical experts be something that could work to decide the direction of NHS?
IHM thinks that there may be some virtue in creating a new cross-party think tank, if only to stop the NHS being used as a political football. It is particularly unhelpful, for example, when politicians become involved in issues such as plans to close their local hospitals.
The notion of bringing people together to agree shared values on the future direction of the NHS must be worth investigating. Medical professionals and healthcare managers should certainly form part of any cross party think tank.
Can GP practices lead change in the NHS? If yes, how?
GP practices are perfectly placed to lead change, but an injection of more resources is essential to enable GPs and staff to have the opportunity to discuss opportunities, and generate ideas and pilots that can be rolled out nationally.
Practices are keen to share good practice and are in a prime position to come up with ideas or give feedback on whether an objective is achievable but they need the space to allow this to happen.
Do you expect more independence to be given to local CCGs?
This seems to be a likely development and has the usual mix of potential advantages and disadvantages. It is important that local services reflect local priorities and CCGs need a degree of independence to make this happen. However, any further fragmentation of the NHS across the country is highly undesirable and greater independence carries this risk.
How can practice managers continue to develop their skills and those of their team members?
IHM believes that it is vital to make both more time and funding available to create opportunities for practice managers and their teams to develop new skills.
IHM is working hard to support practice managers buy giving them a greater voice and by creating new training opportunities. In partnership with the Primary Care Development Centre, for example, we are currently running a pilot Vocational General Practice Management Programme (VTSGPM) in Nottingham.
This dedicated vocational training scheme is an important development opportunity for practice managers, looking at managing self, people, service and the organisation, as well as exploring how they can contribute to improving the public’s health.
Do you agree with IHM’s views? Are you a member and is it worthwhile? What more do you think organisations like this can do to help practices? Please let us know by commenting below or in the forum.