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We all like a conspiracy theory.
The intrigue. The mystery. The whiff of grand deception.
Were the moon landings filmed on a backlot in Hollywood… you know the sort of thing.
It’s with some trepidation that I fear I might be adding to this library of nonsense.
No matter how I may couch what needs to be said. How ever I dress it up… it’ll look like a wacko-conspiracy theory. So far fetched it’ll be filed under B for bonkersness.
Can’t be right. Can it? Well, you be the judge.
Are we… well, are they… them… are they trying to kill off primary care?
Yeh… I know… it’s a stretch. But…
… all good conspiracy theories need a sprinkling of facts to glue the story together. Here are the facts.
Before the election Silly-Boy was stomping around making speeches and referred, on more than one occasion, to the future of the GP partnership model.
He said; the ‘model was in decline’. Indeed, he went further;
GPs’ surgeries said Streeting, ‘would be stopped operating as “murky” private businesses under Labour…’
And added…
… ‘he [was] ‘minded to phase out’ the system of GP partnerships, where self-employed doctors act as contractors for the NHS…’
And, for good measure, he ‘vowed to take on the vested interests of the BMA.’
Well, he didn’t do too well with ‘taking on the BMA’. He caved in and gave them a whopping 20% pay deal.
Putting that to one side, consider this…
‘I’m minded to phase out the whole system of GP partners altogether and to look at salaried GPs working in modern practices alongside a range of other professionals.’
That’s code for polyclinics.
Notwithstanding their costs, past failures and unpopularity.
If that’s not the foundation for a good-old conspiracy theory, tell me what is. It’s at least as good as the moon landing and it’s nearer to home.
It looks to me primary care is being starved into submission. The Treasury has joined in by dumping the huge cost of NI increases on GP practices. As well as running cost inflation and huge demand.
The black-arts of Whitehall? Look at it this way…
… if the intention is to dump the GP partnership model, it can’t be done in the open.
It would cost way too much; buying the practices and their premisses, paying off leases, mortgages, loans and other commitments. Starting a war with the BMA, the public, the press and Uncle Tom Cobley.
Lay-siege to them is much better.
Watch attrition do its work… inflation, workforce costs, regulation, work-load, shedding staff, deskilling… step back and watch them wither on the vine…
.. then scoop up what's left with cheap, polyclinic contracts.
If it is not the intention, Streeting has to learn a basic management truth;
DUDOP… delay and uncertainty, damages organisation’s performance.
It’s happening now. Young doctors are avoiding general practice, experienced doctors are getting out whilst they can.
Work is being deskilled to assistants and associates. Patients ‘signposted’ to physios who mostly can’t prescribe and pharmacists who’ve not been trained to diagnose… and Zumba classes.
DUDOP translates into; increases in locum and cover costs, decrease in morale and engagement, inability to recruit, reduced customer or patient satisfaction, increased risk, the cost of failure demand, lack of continuity and poor strategic planning.
DUDOP creates a vacuum and uncertainty which gossip and conspiracy will fill.
DUDOP has turned the RCGP into a care-home for the bewildered.
The GMC seem terminally confused about their role.
The BMA membership is not up for another round of strikes and the organisations that represent GPs care more about access to ministers than pushing ministers for results.
All of them will fill the gaps with their own Babel of negative narratives.
Streeting has to realise his indecision, his dithering, his stalling and dodging behind a consultation until next Spring, will leave him with a bare-bones primary care that even Lazarus couldn’t fix.
DUDOP... Delay and uncertainty is damaging our primary care.
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