We are not very bright here up North and most of us struggle to count our 10 ferrets without using all our fingers but we have been reading Dr Grumble’s blog and his nice letter from Mr Dave Cameron telling us all about the myths and a reply to Mr Cameron.
Now maths is very hard and we can just about manage to add up and take away on our fingers but when it comes to advanced mathematics like times and share bys we start to struggle. We are, however, as GPs very lucky here in affluent Northernshire for we are so over-doctored that most of the working week is spent on the golf course.
We also have co-operative PCTs, all staffed by Harvard and Yale MBAs, who do our every bidding and are actively embracing GP led commissioning and volunteering to throw themselves on their swords in order to meet the 45% reduction in NHS management costs. The over-doctoring means that each local practice can afford 3 or 4 full time doctors to work full time at GP led commissioning without compromising patient care or, most importantly, time on the links.
However not all practices or PCTs are that lucky. There are many PCTs up North that are well under-doctored. This means that hard choices will have to be made as to how much time doctors in these practices can afford to spend commissioning. Are you lucky enough to live in one of these areas?
GPs often know a lot about illness in their area for they spend time treating it and know what particular needs may be required in terms of specialist services for their patch and it is only human nature to want to get the best for those for whom you are responsible. In order to do that this means being represented in a consortium but this means compromising frontline medical care in order to do so or incurring cost to cover the absent GP’s workload.
Perhaps GP Practices that get along will join up and second a smaller group of GPs to provide services for all but will these GPs be from larger Practices with more doctors or small practices? Will they be full time or part time commissioning GPs?
If you take one GP out of a ten doctor practice to do commissioning than the workload is shared between the remaining nine. Assuming they are all full time, as is the absent from the frontline commissioning GP, that would mean the remaining GPs would get 1/9 of a full timers work added to their current workload. However what about a 3 partner practice where the increase in workload would be 50%?
The UK compared with Europe is under-doctored which means that there is not a huge amount of spare capacity apart from of course in the intergalactic-class Northernshire PCT where ND Central is located.
In order to win wars of liberation you need troops on the ground ideally a volunteer army rather than a conscripted one. Usually when attacking a defensive position it is reckoned you need at least a three to one advantage.
Do we as GPs have the numbers to replace those managers doing the current commissioning and still maintain frontline GP services? Wars have to be fought full time in order to win and troops take time to train if they are to fight well. Do we have both the numbers and time to train the army of GPs needed to liberate the NHS?
If you do not live in a Northernshire PCT like ours you will no doubt be doing mathematics along these lines and perhaps are realizing that the war to liberate the NHS is not going to be easy.
Most GPs are currently fighting full time on one front. Is there the capacity to open a second front of GP led commissioning? Historically fighting on 2 fronts is not usually a good tactic unless you are looking for the defeat of those fighting on two fronts. Those that GPs will now have to become allied with have historically believed the GP to be the enemy. Does that make for good working relationships?
Will GPs be as well equipped and trained as the Allies were on D-day? Will those GPs doing commissioning be full time, fully trained to do so and have all the equipment they will need or will they be a Dad’s army of part timers doing 2 jobs?
If you were fighting a war of liberation which army do you think might do better in terms of a quick victory? Where is this army of GPs to do commissioning going to come from? If they are not available in sufficient numbers, will we have to hire mercenaries to make up the numbers? Are mercenaries the most committed troops to have in a fight?
Anyone done the maths yet and more importantly got the answers?
Praise be to the Party for all of its planning to liberate the NHS. If their maths is correct then it is going to be such a pleasant walk in the park for no patient anywhere will be compromised by their GP doing another job the numbers are so good.
Next stop Berlin or will it be somewhere else?