We have before us the examples of what happens when independent
contractor services become a commodity to be traded in GP out of hours
and community pharmacy. If we cannot see what is happening in APMS and
super-APMS (as in Hammersmith & Fulham) we are not only blind but doomed
to extinction.
Fay


Laurie Slater wrote:
> Jeff wrote:
>
> << Given that you are aware of the of the threat - do you believe that it
> can be averted? Even if you can win this battle - do you believe that you
> can win the war? Can the threat be turned into an opportunity. >>
>
> The patient is the main player here. If the bulk of patients knew what was
> on the horizon they would I beleive actively support us in our goal. It will
> be hard for any elected government to ignore the collective patient voice,
> but naive to think that primary care can continue unchanged in a time warp.
> There are principles which we can promote in offering our services which
> will support the continued delivery of a high standard of care. These are
> continuity of care through retaining the GP list (the lip service which has
> been given to this is fast being eroded) and the idea that patients can
> expect to be seen by a doctor when they are ill rather than a cheaper
> trained up nurse or paramedic. So we need to let our patients know that
> these are in danger and encourage them to be vocal.
>
> In the short term there are a large number of other levers which we could
> use to good effect. Until such time as there is genuine competition from
> outside of primary care these measures are likely to be effective. Once a
> free market economy comes into play they will be less so. Currently it is
> not and HMG seem to want their cake and eat it. Short term we could make
> life very hard indeed for them (as they seem intent on doing with us). For
> this reason I believe that we can certainly win this battle. The skill will
> be in using tactics which don't upset our patients, who we need to win the
> war. But it can be done.
>
> << Your opportunity is IMO about who controls (employs, pays, mentors) the
> "cheap, dangerous, non-doctor driven front line services " >>
>
> We have already played running faster on the hampster wheel in order to earn
> a higher proportion (which tends to stay the same because everyone else
> steps up) of a fixed size of cake. Generally speaking the only financial
> sense is to reduce overheads by becoming larger, which will undoubtedly
> happen. The final balance between size and function remain to be seen. There
> is a danger that in trying to compete and offer cheaper services we lower
> the standard of professional care. So I personally would sooner focus on
> delivering a quality product. If the patients ask loudly enough of an
> elected government for general practice as they know it then we may yet have
> a respite.
>
> Laurie
>
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