A rock and a hard place

10th February 2016 by Richard Fieldhouse

A rock and a hard place

Pressure is mounting on GP services, brought about by a combination of increasing patient needs with reduced resources in primary care (the rock), versus statutory regulatory authorities like the GMC and CQC (the hard place) who, for all the right reasons, have to take an idealist rather than a realist approach to regulation. Whilst their foundation is sound, I don’t think many would agree (including the CQC and GMC) that their message always comes across as it should.

In 1910, Jakob von Uexküll described how each creature has its own spectrum of senses through which it perceives its world, which he termed its umwelt. For the humble tick, its two senses, the chemical gradient of butyric acid (in sweat), as well as heat, enable it to jump from host to host, feeding and breeding. Us humans have our five senses, allowing us each to sense our own personal umwelt. If you could then amalgamate all these umwelts together, from humans, ticks, bats, eagles – every living creature – you would have what Jakob von Uexküll described as the umgebung. Even organisations have their umwelt: police, fire, ambulance services and car mechanics will all take a view on a car crash in very different ways, but it’s still the same car crash.

And it’s this umgebung, at least that spectrum much wider than general practice, wider than primary care, healthcare, that I’m worried about. It strikes me, working as a locum GP in up to 30 different practices a year, that it’s often the somewhat overstretched, under resourced, more demanding practices that need locums the most. So it follows that these practices are more likely to be slapped with poor ratings by the CQC or have GPs under investigation by the GMC. Which from one perspective is great; problems have been identified so solutions can be found, changes could be made, and everyone’s happy. But from another perspective, if those resources e.g. more GPs (whether partners, locums or salaried), are simply not available because that resource doesn’t exist, then what?
I’m not sure we fully realise what the longterm consequences of giving a GP practice a poor rating really are. If you were looking for a partnership or salaried post, would you apply for a permanent post there? How long do you think you’d be able to hang on safely locuming there? You may of course enjoy the challenge of supporting them and helping turn that practice around, but your energy and patience are not endless.

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