The Future of General Practice

It sounds a rather portentous title really and certainly a few years ago, debating this subject, would have been a signal to increase the required dose of Olanzapine. However of late, it is no longer a rhetorical question and it is being suggested that the current model is no longer tenable, with even GPs themselves not being flexible enough to make the necessary changes.

General Practice is not thought to be in a great place at the moment, the worst crisis has been mentioned (though to my certain knowledge a crisis in General Practice has been a recurring theme over my years in the profession), however this may well be an appropriate use of an overused word. From my experience, which is now longer than I’d care to admit to, (though the grey hair is sadly a clue) GPs are among the most flexible of professionals.

When I started in General Practice, we had paper notes, no computers, repeat prescriptions written at the bottom of the page then scribbled out and written again and we were just experimenting with the introduction of a nurse! We now are virtually paperless, have more practice nurses than you could shake a stick at, an onsite pharmacy, district nursing team, dentist, physio, mental health team, osteopath, health visitors and Councillor. The building is modern and pleasant to work in and we have fully merged with three local practices, which has changed and improved the ethos of the partnership. Car parking is a problem, but at least we aren’t charging for the pleasure…yet! Yet although the environment has changed and much for the better really, the innate way of consulting has not. We remain first port of call for undifferentiated medical problems and deal with them in roughly ten minute aliquots (on a good day), but thankfully with less home visits than in days of yore. There is something to be said for this particular model, before we chuck it away in a flourish of three letter acronym, such as MCP and PACs.

“We GPs deal with uncertainty well and are extremely skilled at untangling often a very vague story and then making a sound decision on often minimal evidence. We do this quickly and safely and in these cost conscious times, very reasonably. To borrow a well-known slogan, we are probably never knowingly undersold!”

We offer continuity, where it is needed and a holistic approach to problem solving, which is valuable at a time when many problems presented, as entirely medical, are anything but. Over 90% of all contacts in the Health Service take place in our surgeries. In hospitals there have also been changes, with the introduction of sometimes miraculous new treatments. However, specialists, though more numerous, have become ever more specialised, woe-betide you if you end up in the wrong medical pathway, Hampton Court maze would be a better option. We on the other hand don’t give ourselves enough credit for treating more than one condition at once and multiple, sometime related (but often not) problems in that same 10 minute slot.

I’m not advocating that we stay the same, we have evolved and we need to continue to do so. Bureaucracy and regulation have become huge complications to our professional lives and have made the job of a practice manager in even a moderately large practice a nightmare.

There are not enough Doctors at the moment and probably never will be, so we need to share our jobs with others professionals, somehow keeping the most important parts of our role, while preserving our sanity.”

Practices working together at scale, either as a super-partnership (certainly my preferred option) or a robust federation, from my experience, can make our lives easier and still preserve the vital core model. Closer working with community teams and our consultant colleagues is also inarguable, though perhaps massive contractual change is not necessary for this to happen, but the pros and cons of MCPs is perhaps a subject for another day (if I’m given the chance!).

Perhaps it’s because the winter sun is now filtering through the window and the drizzle has stopped, but I believe we have a vital role to play in health care. General Practice is still a great career and we are rightly valued, by the vast majority of people, with the odd exception, who is perhaps getting a bit too mithered by Brexit and keen to create a few handy smoke screens round A/E departments!


Dr Gavin Ralston – Chair, NHS Birmingham CrossCity Clinical Commissioning Group

Dr Gavin Ralston – Chair, NHS Birmingham CrossCity Clinical Commissioning Group

Gavin went to Birmingham Medical School and has lived in Birmingham since 1979. He has been a partner at Lordswood surgery in Harborne for 24 years, where he helped redevelop the surgery and merge the practice with three other local surgeries to form the Lordswood Medical Group.

He developed an interest in commissioning after sitting on the South Birmingham Primary Care Trust professional executive committee for three years. Together with a small number of colleagues, Gavin helped to form Birmingham CrossCity CCG.

Gavin believes in the value and benefits of using doctors and healthcare professional to help shape healthcare for Birmingham and aims to ensure that services for all patients are more flexible, joined up and effective; the kind you would be pleased for your family and friends to use.

In September 2016, Gavin was appointed to the BMA’s GP committee executive team where he using his experience as both a GP and a commissioner, to ensure that general practice thrives and not just survives.

1Comment
  • Elly Stanton
    Posted at 22:12h, 25 February Reply

    I agree with everything Gavin has written here, especially the bits about General Practice being the most efficient and cheapest way to deliver healthcare safely. Just to let you know, my practice in Walsall was taken over by a private company called The Practice Group last summer, and they immediately started placing unreasonable demands on us until I accepted a full time job with the other practice I work at, who remain an NHS practice. This triggered an exodus of other staff who have also been offered positions there until you could now call it a mass resignation with 4 other staff moving down the road and possibly another 2 to go.

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