Column

Considering a leap in the dark

GP Katy Gardner ponders the pros and cons of becoming a trust employee

En route to a meeting in Newcastle – ‘A salaried service: opportunity or threat?’ – today, I read a graphic account of the recent respiratory syncytial virus outbreak which has laid low the country (how do you tell a person with severe pleuritic chest pain to go to bed and take aspirin?).

Meanwhile the wheels of change grind on, deadlines for pilots slip by (oops, just missed the last one), and the Primary Care Bill works its way through Westminster with the BMA bravely battling over amendments.

Caution is the word in Liverpool and at a recent LMC meeting fantasisers were few. However with a rare calm in the practice I am day-dreaming (as neighbourhood commissioning rep, with a patch of about 90,000 people) about a neighbourhood primary care trust or negotiating a salaried service via our community trust.

Why bother if things are looking up? Inner city Liverpool has many small practices struggling with recruitment and premises problems. While this definitely affects the morale of doctors we must not lose sight of those forgotten creatures: the patients. All this upheaval must be to benefit patients — not only to provide better access to physiotherapy, counselling or whatever, but to preserve the unique relationship at the core of general practice.

To be employed by a trust I would have to know that the trust understands this. I would have to know that the trust cares for its population and its workforce — not just for its finance and contracts. I would have to know that the practices employed would be allowed autonomy and that practice teams and practice development would be encouraged.

I can see that with the right culture in trusts and health authorities, advantages could be considerable. Our community trust, for example, provides mental health services already — skill mix and skill sharing would benefit those in the inner city, many of whom suffer great mental distress. Networking across the neighbourhood could bring exchanges of ideas and skills among primary care teams.

The bureaucracy of GMS form filling would decrease, although it would risk being replaced by planning and a more needs-based public health approach, not without its own bureaucracy.

Various salaried contracts might exist — a 3 year floating locum post for doctors going on sabbatical, women doctors working part time in several all-male GP practices, and long term consultant-type contracts for some, built in career development options, crown cars — or at least compensation for damage and vandalism — and secure and well-maintained premises.

This would all depend on understanding and good will and it must, somehow, be accountable not just to trusts but to communities. At the meeting Julian Tudor Hart shared his idea of a primary care scheme to employ GPs in the Welsh valleys. I can see the excitement of employing GPs, as we have in the out-of-hours co-op, but there are disadvantages too: bureaucracy, a big leap in the dark, and no time ever to just ‘be a GP’!

But I’m still day-dreaming, thanks to those Newcastle doctors: maybe flowers can bloom in the inner city.