1) We would like more GPs, and we will train more, but this will take ages.
In the absence of a secret GP growing tree, GPs should concentrate on things that work and stop doing things that don’t work.
No more Healthchecks programme, end dementia screening, no targets for writing advance care plans (done instead when clinically judged to be useful), no more QOF target chasing. No pledge or promise will be made without opportunity costs being calculated and the additional needed resources put in place.
To prevent the recurrent problem of accumulating non evidence based work, all new work decided by political policy will have to go through an independent Evidence Desk where benefits and harms will be examined. There will be trapdoors.
3) Repeal the Health and Social Care Act. Stop commissioning. Let all the GPs sitting on boards go back to seeing their patients. No more waste with competition, mergers, tendering; no more private providers. At every opportunity, take things back into the NHS.
4) The NHS should be based on fair use. This means that people with the most needs get more resources. Hopefully, as we stop wasting so many resources, there will be more to go round. In the meantime, that means that ill people get seen first, and people who are able to wait are asked to do so. Instead of chasing access targets to see a GP, ensure that access is based on need first. Prioritise continuity of care, which GPs and patients usually prefer.
5) No more non evidence based public health campaigns. If any media campaigns are run, they should be trialled, with an evaluation of harms. For example, did all those ‘catch it early‘ winter campaigns result in more GP appointments being used rather than less? Entirely possible – when people used non EBM treatments from pharmacies for self limiting illnesses and didn’t get better in 24 hours did they go to their doctor sooner? Raising expectations is unfair.
6) All private health screenings and genetic home testing kits follow up should be dealt with within the private sector. It is not acceptable for patients to have their money taken for numerous non evidence based tests, to be handed a pile of paperwork, and told to discuss it with their GP. The private sector should take full responsibility for all follow up. If they don’t (and they won’t) a tax is payable on them all, to go direct to training and paying for more GPs.
7) The pharmaceutical industry supply chain is enormously erratic. It results in GPs having to change prescriptions frequently because the prescribed generic medication is not available. A private business model is clearly not efficient and GPs are picking up the pieces, leaving less time for patients. The pharmaceutical industry will be invited to draw up a contract to ensure stable supply and fined for non compliance.
8) Halt CQC inspections of GP surgeries. The paperwork is distracting and the results uncertain. Work towards a model of ensuring basic standards are set in all surgeries, but assist GPs to use peer review to learn and support each other. Transparency over all outcomes should be normal, but understanding and making clear the data and uncertainties, and support rather than blame should be expected.
9) All health policy makers and practitioners should make their declarations of interest known publicly. Post graduate educational facilities should be made available at cost to HCP to enable sponsor-free learning.
10) Let GPs get back to the job they love – that is, getting to know their patients, having conversations over time, understanding what’s important and what’s not, sharing decisions, making plans, supporting families, understanding the area they work in. Make GP the incredible job it is.