Feature

A foot in both camps

Rosa Hudson has dipped a reluctant toe into the chilly waters of NHS planning

Eighteen months ago I wrote about neighbourhood commissioning and here I am, GP neighbourhood planning rep for 18 practices in five mainly inner city wards. Liverpool has gone for a locality/neighbourhood approach, not involving the devolution of budgets (yet), but creating a neighbourhood planning team including a public health consultant, a CHC rep, a health promotion rep and several others with the task of influencing the purchasing plan of the health authorities and making it more responsive to local needs.

Of course our health authority has to cut millions of pounds from its budget this year so we may only be looking at a damage limitation exercise.

Luckily, I had thought about these issues for some time before starting my new role, paid at the glorious rate of one whole session per week. The money has given me a little time to sit and think, and I’ve had a wonderful time meeting local GPs and some amazing nurses and health visitors who I had never previously encountered.

Our team has just started meeting and we are all floundering in the dark but at least we are floundering together. And local practices are meeting together. Most exciting of all, a new health group has formed in the community and we have already worked effectively together on the future of children’s services in the inner city.

Of course, it is fraught with problems. Will I feel disillusioned if the ideas we have come up with come to nothing because of cash cuts? How will it actually feel to say that we have to take resources away from one area to put it into another? How can we convince GPs that they don’t have to refer every person with back pain to an orthopaedic surgeon?

One neighbourhood in Liverpool is asking for its own budget. It is the one with all the rich people, and a fundholding practice that has already bought its health visitors from another district! How would the rest of us fare if this neighbourhood decided to go it alone or become a super fundholder? Will any of us have real power if we don’t hold the actual purse strings? The FHSA assumes we will have.

Will effective public input be possible? The FHSA/DHA has just arranged a public meeting in the neighbourhood for people to discuss the purchasing plan. But most people have no idea what a purchasing plan is and still think we have the old Area Health Authority!

The burning issues that have come up so far have in fact not been about surgical waiting lists but about facilities for stressed and frightened people in the community, about counselling, about anxiety management, about help for people with drug and alcohol problems. Plus a huge surge of frustration with social services provision, and the workings (or rather non-workings) of community care. These are all issues dear to my heart.

We are still very short of doctors in our practice and GP trainees seem like gold dust. Perhaps if we GPs can grit our teeth, get through the paperwork and re-educate ourselves to a much more public health/planning role, we can really help to create a primary care — even a social care — service which responds to local needs. Let’s make sure the medical students know about this!