Column

Planning for dreams?

Rosa Hudson wonders whether general practice is on the right track

Neighbourhood commissioning - is it a light at the end of the tunnel or a dead end? Assuming, of course, that we know what it is. We don’t, but then everyone seems to be doing their own thing lately. Maybe that is the ultimate in locally controlled health services. Each small area doing its own thing. It has to be better than each practice doing its own thing...

In our health centre, we have realised that we must act positively to face the changes, or be left, along with other practices in the city, as second best. So we got our local medical committee interested in looking at some kind of locality commissioning for all the non-fundholding practices. The committee has even had discussions about local community organisations being involved in a local commissioning team along with GPs and possibly - hopefully - others in the primary care team.

As part of this, following work we were doing last year on local health problems, we have become a sentinel practice in a project looking at how data from general practice can be made meaningful. This is happening now with six other practices in the region.

My pulse reaches about 150! Is this the way forward? Can we really find out what our patients need - and what they want - and make some sense of it? With regard to resources, I don’t see the possibility of a huge cake, and I would swap varicose vein operations for community psychiatric nurses anytime, but there must be some incentive to spur us on.

GPs in east London drew up a ‘wish list’, only to find their was no money to pay for it. We had this idea too - to record our fantasies of what patients might benefit from in an ideal world. Somewhere the ideal and the real might coincide, and make all this worthwhile.

And what of the patients? I’d love to sit quietly in a university department for two hours a week just thinking, but this would involve a lot more than just thought. It would need time, and plenty of energy. We must be paid for our time and not be drowned in another wave of meetings. But even if we are paid, where does the time spent with our patients go to? This year, for the first time in 15 years, we have not been able to find a trainee GP. Where have they all gone? Is it because they already see a contradiction between the GPs that we are, sitting back, listening, finding time to empathise, and the GPs of the future who, maybe for all the right reasons, sit in meeting rooms planning for a dream?