Clare Gerada: There is a better way forward for the NHS

It was a rude awakening with me being plastered across the media – on the radio, the TV, and in the papers.

I had dared to say the Health and Social Care Bill was a mistake.

The Government insisted the changes would lead to better outcomes for patients. Only time will tell. But early evidence suggests what we feared chaos, confusion and an incoherent policy. In my view, in 10 years time, I predict, the NHS Act will be viewed as one of the historic misjudgments of all time.

Going forward, we must be brave. The last three years have taught me an important lesson: when all around you appears to be in chaos – when you feel you’ve lost your way – when you don’t know what to do next, stick to your values!

And we as GPs will need to stick to our values over the coming period as there are likely to involve changes that affect all of us. These changes won’t affect what we do – we’ll still be providing first contact care to patients in practices close to their homes.

But one of the things that must change is our relationship with our specialist colleagues. The way we work with them will change for the better – and the change will benefit us, them, and our patients.

The them-and-us divide – symbolised by the hospital entrance – will become a thing of the past. In future, we will be working together in one integrated system of care.

But in order to make this happen, we’re going to have to ask – and answer – some difficult questions about the way we do things. Our current health care system was set up to meet the needs of the population of post-war Britain.

It was a time when the sick either died or got better.

Nowadays we live longer. Nowadays there’s a growing number of patients with complex multiple morbidity – patients who wouldn’t have survived in the early years of the NHS.

We have to urgently address the twin scourges of our health system: Poor continuity of care and fragmented care.

Both made worse by the Health and Social Care Act.

Both made worse by multiple providers, competition and a market-driven Health Service.

And both made worse by perpetuating the divisions between hospital specialists and GPs – between providers and commissioners.

But we have it within our power to change things. I’m not talking about major structural reorganisation.

Definitely not! Let’s put an end to restructuring – we’ve had far too many restructures in the last two decades.

The changes I envisage are not structural. First and foremost, we GPs are stewards of the NHS. But if we’re going to secure its future, we have to evolve with it. We must restore continuity of care – the tool of our trade.

We have to go forward together – and it will involve grasping some nettles!

We will have to examine historic systems – like the independent contractor model – and ask ourselves: is this 1940s model – created as a pragmatic solution at the time – still fit for the 21st century?

We might also need to look at how we work together as small businesses, and ask the same question. I believe GP practices working in isolation have served their purpose well, but their time has passed.

Instead we need all providers of health and social care, within a geographically aligned area coming together and pooling resources.

The RCGP federations could then evolve into integrated care co-operatives – provider organisations 
led by GPs.

The aims of an integrated care co-operative would be to reduce fragmentation of care, improve continuity, deliver care as close to home as possible, and deliver best value for money.

Primary, community, social and acute care budgets merged into one budget. In other words – integration.

Ironically, if the coalition hadn’t imposed its unwanted and unnecessary top-down reorganisation, this move towards integration would probably have happened anyway. There are many examples past and present to call on.

The College has started a campaign calling for Fair Funding For General Practice. We’re demanding that 
general practice gets at least 10 per cent of the NHS budget, and at least 10,000 more GPs.

I’ve made the case to the Prime Minister, to the Deputy Prime Minister and to the Leader of the Opposition and any other politician who will listen to me.

And the College will continue to speak truth to power; tell it how it is – and drive home to those in high office that for our patients’ sake general practice needs more resource.

So, despite the problems we face now, I believe the future is bright for general practice – but the simplest and best way to get a better health service is to invest in primary care.

*Dr Clare Gerada is the chairman of the Royal College of General Practitioners. This is an edited version of her keynote address to her organisation’s conference in Harrogate yesterday.