hoolet issue 41 

Summer 2004

Chris Johnstone Intro.
Academic General Practice and Primary Care in Scotland
Mayhem Clock and Anti
The Complementary Garage
EPASS goes live!
Its your MLG
Changes to Postgraduate Training
Take Control
Did You Know??
Smoking in Public Places
Who Are We Kidding on Confidentiality
The Body in the Library - Review
Smoking out the Irish Question
Swimming in De Nile
Glasgow Gals - Sex Alcohol and Religion

Crisis, What Crisis?

By Chris Johnstone
Contact the author by e-mail at christopher.johnstone@ntlworld.com

Change. Change is fun, learn to love change. Embrace change. Change is your friend. I know all this and I am trying to come to terms with it. And anyway even if I don’t love change, I have to put up with it. The myriad of unemployable beaurocrats who run our lives have to justify their existence and paycheck and they do this by smothering us in change in the name of doing something. In our Health Board we have had so much change that we are back to where we started. It is quite common to get to where you began, the difference now is that the length of time we go round in circles is decreasing all the time. We are increasingly spiralling in on ourselves. As the rate of change accelerates we will soon be so advanced that we will back where we began before we have even set off.

The other reason to accept change is that it is our lot whether I like it or not. So as change accelerates I rush headlong into advanced middle age. The beauty of aging is that I get to be set in my ways. I like being set in my ways, it’s easy and does not trouble the old grey cells. I slip into my set ways at the beginning of a surgery and time passes without a hitch until it is time for a habitual coffee and single chocolate Hobnob. How I rush with open arms towards a well-earned retirement. But oh no, not on your Nellie. Change this and change that and change this back again. No time for sliding into mediocracy. It is all very unsettling, I know where I stand, but then I am moved and the view changes and I get very unsettled. And this is what I am at the moment, unsettled.

I am not sure why I am unsettled, which is unsettling in itself.. Change is overwhelming and I now struggle to keep up. The new contract is ruling my life, my computer system is not up to the job. I cannot trust its searches, I am not sure which codes to use, I am having to spend a lot of money on extra staff to set and run and monitor a variety of recall systems. Change, too rapid change. On top of this I am unsure of how I am being paid. I don’t fully understand the MPIG and how our staff are being reimbursed. We seem to have tied ourselves into a historical underpayment system despite being in one of the most deprived areas of Britain.

On top of this when I attend local management meetings of our new CHP and division or at the hospital, I hear everyone talking about all the extra money for primary care in the new contract. They all seem to believe that the money is everyone’s, not just GPs or even primary care’s. Lots of people are eyeing the new contract money with greedy stares and they all hope to fund their changes with our money. All very unsettling.

One area where we are going to be under increasing pressure is intermediate care. As more hospitals are closed in line with financial pressures and the working time directive there is going to be a demand for GP led cover for intermediate stay beds locally. When patients are discharged from the blue light hospitals they will be sent to local intermediate stay beds until they are fit to be sent home. There will be no hospital doctors to cover these beds and it will fall to GPs to provide this cover. We could all become cottage hospital GPs, even in the middle of our cities.

Where will they find the GPs to do these jobs. Colleagues are finding it harder and harder to find new partners. When they do find someone it is almost impossible to get anyone to work full time. The new consultant’s contract looks very attractive, with large pay rises for some and reduced hours. Where did we go wrong? The chances of hundreds of graduates rushing to primary care is likely to decrease not increase.

Maybe I am worrying unnecessarily. Maybe it will all come good. I’ll let you know.

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