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As a rule, I dislike Americanisms, but as this expression suits so many of the new initiatives we face in the NHS, I will give it house room.
I sat in a meeting recently when, as GPs we were ‘consulted’ about changes to community services. Now call me cynical (I put it down as one of my middle names) but whenever we are consulted about a change, what is really meant is the decision has been made and discussing it with us is a meaningless tick-box exercise, so that someone in an office far from the frontline, can say GPs were given an opportunity to input on the policy change.
This particular consultation involved changes to leg ulcer dressing. It is proposed that instead of funding us to do this work in house, community hubs will be established where patients attend for their leg ulcers to be treated.
Now my very first issue with this is, with all the problems general practice has, leg ulcer care provision is not top of the list. In fact, it would not even make the top hundred problem shortlist. So why has some bureaucrat taken it upon themselves to change this?
In our practice we have four highly competent and experienced nurses who undertake the leg dressings for our patients to a high standard. We even send our nurses out to visit housebound patients for leg dressings, such is the dearth of community nursing provision in our area. In short, we don’t need a change to this service.
I should add the remuneration we received for this covers the cost with little or no profit to ourselves, so we are offering this as a service to our patients.
The proposed community hubs for leg ulcer dressings will be centralised. First problem, how will our patients get there? Most are very frail and elderly and cannot drive, so is this new service going to offer transport?
Secondly, what will the wait be? Currently we offer a same day service for leg ulcer dressing. What I mean by that is, if a GP sees a patient with a developing leg ulcer, or the beginning of tissue breakdown, we will get them seem the same day by one of our nurses. I cannot see a community hub we have to refer into, being able to offer this level of expediency.
This is a small example, but highlights the principle of how little, those supposedly in charge, understand about the actual problems we have in primary care and what our priorities for change would be.
My message for the ivory tower dwellers who make decisions for us is this: Don’t guess what we want, if you really want to help primary care let us set the priorities and follow our lead, after all it is us who are fighting on the front line with increasingly fewer troops and rapidly dwindling ammunition supplies.
Paul Coleshill is a GP. He writes under a pseudonym
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