21st January 2015

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Health-Chat with Roy Lilley 

Dr Sarah Woolaston MP Chair Health Select Committee

11th March - King's Fund 5.30.  Details here.

Rolling up our sleeves
News and Comment from Roy Lilley

What's the future of primary care in 2020? Simple enough question. Much harder to answer, as I found, trying to herd-cats, at the HealthChat evening on Monday night.


Phil Hawthorne captured the evening in his excellent blog and here is the Twitter feed; so I won't recite events. However, we never reached a conclusion and it is too important a topic to just leave hanging.


Here's how I see it. Pressures of demand, costs, resource reduction, GP scarcity, undevelopable premises and no money says; circle the waggons.


I'm not convinced anyone has a clue. Uncle Bruce, in this rather forlorn interview in the Guardian, describes the conundrum perfectly.


GPs are a highly vocational lot and rightly want to hang on to family-practitioning. The NHS system, the way it works, we love it. I confess I am as mesmerised as the rest. At its best, a world beater. We are hard-wired to love it but there is a major fault line in our thinking.


There is more to this than logic. Logic gives us stone-bonkers answers to questions; scarce resource = circle the waggons. The problem is we let bias get in the way.


There are five biases that prevent primary care moving on.


Group Bias. GPs, as a group, forge tight bonds and alliances and are suspicious, snooty and frightened of anyone, outside the group, that tries to change anything.


Status Quo Bias. This leads us all to make decisions that look like change but actually, pretty much guarantee things will remain the same. History tells us, more resources don't mean change; more likely more of the same.


Negative Bias. The papers are full of negative NHS stories; bad news is seen as more important because it is more likely to threaten us. GPs are stuck in a spiral of negativity; blamed for not finding enough cancers, prescribing too many antibiotics, not being open for long enough... blah, blah. Their low morale mitigates against being open-minded to change.


Bandwagon Bias. Flows from negative bias sometimes called 'group-think'. GPs can't see a way out of their maze without prejudicing or sacrificing the bits they love and value the most. So, they'll muddle on.


Locked-in bias. Because there is no clear vision of what Primary Care will look like in 2020 GPs can't imagine themselves being part it. They become anchored in a present; a product of a past that has got gradually worse and they are convinced the path to the future is more down-hill.


Fix the five biases and you unlock the secret of managing change. GPs are people and people love change... when they feel they are in charge. GPs are pushed around by everyone with an opinion to air and a vote to win. GPs must feel like the flotsam and jetsam of the NHS.


What is missing is a leader. Leaders are visible, have a vision and share it often.


I don't see a GP leader, a personality, a character. I don't see someone honest enough to say more of the same won't wash. I can't hear a well communicated, clear message. I don't see a character with a sense of humour, a morale changer. I don't notice someone with the confidence to take on the naysayers and doom-mongers. I haven't watched a creative mind paint a picture I could walk into.


All I see are committees, groups, organisations, papers, talking and a lot of dancing around hand-bags. We are in the grip of analysis paralysis. I sense hopelessness. GPs are waiting for something good to happen to them.


I have news; it won't. The best way not to feel hopeless is to do something; create hope.
The 5YFV makes it clear GPs have to sort this out for themselves but I'm not sure the present organisational structures, the affinity groups the DH or the Carbuncle has anyone wearing their underpants over their trousers.


Of one thing I am sure; yesterday is history and tomorrow is a mystery. Today is the day for rolling up our sleeves. 


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