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What’s up, doc? Don’t you want to run the show?


“Tennis elbow jab makes it worse,” said the headline, six weeks after I’d had a jab for tennis elbow. “Is it like RSI?” I had asked my doctor. “No such thing as RSI,” he said, “that’s a made up diagnosis”.

“Well, strictly speaking they all are aren’t they?” I said rubbing my arm and we chatted amiably about the state of the nation and GP waiting times before a receptionist bustled in, said we were holding things up and offered to give me some antibiotics.

My GP does not want to run the NHS. I asked him. He said he was busy doing what he was trained to do but thanks for asking anyway. And I think he’s right. The best GPs are the best because of their clinical breadth, their patient focus and their person skills. Why would we want them doing other stuff? Why do we reward people who are good at something by getting them to do something else and calling it promotion?

‘Healthy eating initiatives are greeted by burger wielding fat people demanding their children be afforded their rights to as many chips as they can eat’

Of course, one of the big problems in any commissioning process is anticipating and valuing particular services. Take, for example, under age drinking. Alcohol Concern published a report last week saying that underage drinking is costing hospitals around £19m a year. The UK has the highest number of alcohol related injuries among young people in Europe. Alcohol contributes to 5 per cent of their deaths.

How can any service commissioners legislate for the range of influences and circumstances that create widespread underage drinking? How can they legislate for unpoliced shopkeepers selling cider to 13 year olds or parents ignoring their kids?

Let’s face it, we know health choices are constructed from lots of different things. And we know that most common sense responses to public health issues that affect kids are not always well received. Sex education in schools, as a response to an increase in teenage pregnancies and sexually transmitted infections, is greeted by angry Victorians demanding nobody mentions genitalia near their children until they are 26. Healthy eating initiatives are greeted by burger wielding fat people demanding their children be afforded their rights to as many chips as they can eat. And education around alcohol and its effects are dismissed as prissy and too interventionist.

Our problem it seems is that we can be outraged by modern health problems - and equally outraged by the proposed solutions. We don’t like drunk children, we don’t like their parents, the shopkeepers, the marketers, the doctors who tell us our kid has alcohol poisoning, the nurse who goes into school and talks about the dangers of alcohol, the peer group who leads our otherwise angelic child astray or the NHS for not having the right service in place for this particular problem.

Why would GPs want to take on responsibility for all this? Shifting the onus of commissioning mostly means shifting the blame. I wonder if health services can ultimately be expected to cure social problems? Or perhaps their function is not to cure them but to be seen to address them and be blamed for their recurrence? Health services as national punchbag? Why would GPs want that job?


Readers' comments (4)

  • it seems that to do commissioning successfully it is a full time job and gps should chose which route they wish to take. or they need to do part time in each but you cannot work as a full time gp and do commissioning in a responsible manner and give optimal care to your patients - mistakes will be made and services could deteriorate with the patient ending up with the wrong or mediocre services. looks another case of government and management interfering in clinical areas they know nothing about and causing even more financial waste, resources waste and another total mess up to the cost of the public and patients. the nhs used to function extremely well and was considered one of the best in the world - even though things have moved on in modern medicine why can't we use the original model with modifications adapted to modern medicine or have clinicians in charge with the support of administrators for non-clinical services but who work in collaboration with the clinicians instead of trying to manage areas in which they have no knowledge or expertise apart from the skills of sitting in offices all day long talking and drinking coffee.

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  • The GPS in my surgery are so part time we rarely see them -despite massive wages- so I am sure they will have plenty of time to focus on commissioning especially if it means they can trouser as much cash as they did with fund holding that was a disgrace-hope this is not the same

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  • fine, well then with all the time available they are in a good position to do the commissioning but it must be done well so that patients get the best possible service and perhaps they should give up trying to see the patients as well if they don't have enough time to devote to them and their needs.

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  • My GPs seem to struggle to run their own surgery with 2 partners, with whom it is nigh on impossible to get an appointment, then a round of trainees and locums. I can't see how they will manage commissioning. Maybe that's why you can't get an appointment with them - they've been buried away commissioning for years. Whole idea seems ludicrous.

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