Another day, another health-chat? Well, maybe not – this really grabbed me at the beginning…
And you know I really do like quotes!
“A doctor with a stethoscope and a Cheque book achieves more than a doctor with a stethoscope”.
This is my summary, opinionated as the participants, of the chat between Roy Lilley of NHS mangers .com fame, and Dr James Kingsland, OBE, erstwhile GP, innovator, practical realist and has been there and got the T shirt…
Serendipity and overtly specialised secondary care made him join a GP Training Scheme. Specialists vs. Generalists. Or, as James put it Generalists vs. partialists! Thanks from us all to the ENT Consultant who referred one of their patients to a Dermatologist and James realised he could deal with it, and didn’t need the cost and upheaval of transferring care. Thank you, whoever you are…
Trained at Liverpool. Still a partner in Wallasey (posher bit, on Wirral peninsula, over the water from Liverpool. Scousers call the inhabitants “woolly backs”, due to them having sheep in fields near them…). He became senior partner at 30 due to two retirements and then an untimely death…
We had the angry tour through the endless, meddlesome reforms (including the sensible swipe at Lansley madness). There was much discussion about perverse incentives built into the systems. About some good nuggets of utility on some of the sweeping changes. Fund holding could work if you used it right. This was the start of what has evolved into Primary Care Home (Roy…”yes yeah – we’ll get onto that later…”). We did.
I chatted to James afterwards. He took great pride in being the only GP who Mr Lilley has never manage to insult. This acted like a perverse incentive of course, and Roy’s gloves were off.
Here’s the start, just 3 minutes in if you are going to watch the you tube player repeat of the event…(click here for that)
“How many GPS do you have then?” “4 partners, 2 Associates and 2 or 3 in training at any one time”. “So you’ve got 10, 12 thousand patients?” “No, 6000,” “well, no wonder you can offer such access – you’re over doctored! That’s outrageous”. “Why is immediate access outrageous?”.
I warmed to him.
The model works. It pays, whether it is over- doctored or not.
(Here’s an article explaining it – from James: it is on his LinkedIn page – you may need to be a member: Understanding The Primary Care Home just click on the blue bit…)
Is the NHS being so bottle-necked because of lack of Social Care? It’s possible, but also possible that a system that saves 4% of its budget through business efficiencies, year on year on year must be doing something that needs to be copied?
It is the change fatigue that James’s way of working and thinking is attempting to stop. Keep the organisational memory, so that we can keep the good and add to it. So simple. But you have to be confident that the willing are following you. It’s the people who make it happen.
Societal change does have to be catered for, of course. And I still contend that there is no one size fits all solution. That goes for individuals too. Our own healthcare needs keep changing from immediate need for an acute episode, where we will be happy with any healthcare professional. To a longer term condition that requires a little more TLC and continuity – when we want our main professional partner to keep a watch on progress.
Is there a difference between accountable care organsations and Primary Care Home? Is Primary Care Home just really the Buurtzorg idea (click here…I think Burrtzorg should be rolled out over the current UK…see RCN view here), but amplified beyond fully featured nursing care (including prescribing and referral) to include all health care professionals?
I like the empirical approach. If it works then do it and get the evidence during practice, not as a trial. Polish, don’t start small and hope scaling will work.
Is it simple? Maybe it is. The model as described is what most patients thinks is what happens in their surgery anyway? The triage system at reception (first contact…either physical or electronic or phone), means the patient is directed to the right sort of health care professional, first time, every time. Now Roy expressed shock that untrained staff were given such responsibility. I say, get over yourself, Roy! It is working. It needs new skills inputs and protocols and algorithms. But if it works, why knock it? The partners will still be the ones who go to the GMC or jail, if it all goes wrong, so they must feel confident.
You need horizontal integration of the various professions – which can include some secondary care personnel. You do need a coalition of the willing, the committed, the trusting, the excited. And a bit of size for muscle. 30 to 50 000 patients. Back office savings, then. And of course, a bigger Cheque book goes with size. I say horizontal rather than vertical because it is a flat interlocking model of different professional healthcare people picking up leading the individual patient needs at the exactly correct moment. What’s not to love?
Sometimes you just have to believe. Start empirically and with organisational memory to build on, not chuck away. Then check and refine in practice.
Then you have a winner…and I think James Kingsland is certainly one of them.