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Martin McShane: The dog that hasn’t barked

4 Feb, 11 | by BMJ

Martin McShaneAs we wrestle with uncertain futures, financial stringencies, and retaining a focus on ensuring services continue to get delivered, there is a creeping realisation that something is missing.

There is a bill before Parliament which details, in jargon that defeats me, the changes to the structures for commissioning. It lays out the way the system will be regulated and steered towards the new dawn. At its heart, at the core of this radical change, is the premise GPs will be willing and eager to pick up the challenge being laid at their feet. Why will they?

An email arrived in my inbox detailing one of the problems with this premise. A GP who is willing to try and make the reforms work is having a bit of difficulty persuading his partners to release him for the requisite time. It is not for lack of money – we can fund backfill time (though in dispensing practices that could exact a high price). It is simply that the partners don’t want to have to do more work than they are doing already and locums are like gold dust. We are going to need a lot of clinical backfill in the next two years as GPs take time out for development and training to acquire the skills needed, even if they employ a raft of managers, which I don’t think is the intent of the reforms.

Even if we get a cadre of GP commissioners in place (and I am fairly optimistic that is possible) there is the other issue – the really important one. What are the consequences to GP practices and GPs who simply don’t want to engage? What happens to those practices who, despite peer pressure or appeals to their ethics,  their morals or any of the other influencing techniques that don’t involve a fiscal penalty, refuse to play ball with the reforms?

As one young GP said at a meeting recently, “I have been trained to be a system resister, to put the interests of the patient in front of me ahead of the system, so why do you think I want to be a system manager?”

What is going to make GPs who are reluctant, indifferent or obstinate play this game? Something is missing.  Where is the contract? What is happening to the contract negotiations? It has all gone quiet. The era of using money to incentivise with largesse is surely over?  However, the dog remains quiet. It is not even barking – let alone providing any bite!

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.

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  • David Baker

    I am somewhat perplexed by Martin's comment, ” It is not for lack of money – we can fund backfill time (though in dispensing practices that could exact a high price”).

    I am at a loss to understand why dispensing practices' backfill should cost more than prescribing practices

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