The very nature of general practice in the UK is being challenged by ‘progress’. Progress in new technology. Progress in personnel and health and safety legislation. Major changes are taking place in the way GP Practices are expected to provide services, how theses services are funded and managed and finally how standards are monitored and measured.
The Care Quality Commission now expects a GP Practice to work to the same standard as NHS Hospital Trusts. The CQC expects GP Surgeries to be run professionally and to be able to demonstrate their professionalism. Looking through the many reports already issued by the CQC it is clear that many practices still have not got the message. Looking back 50 years or more a GP Practice Manager was a rarity. A surgery might simply be two rooms in the doctors house. There were no computers. There were few practice nurses, only doctors seeing patients twice a day without appointments until the last patient had been seen. Telephones were also a rarity as patients would simply turn up sit and wait to be seen. Records were kept either on wooden shelves or in wooden four drawer cabinets and were often strewn around the consulting room unfiled.
The change in the way doctors surgeries are built, manned and managed has changed slowly over my lifetime. Doctors started to employ more staff from 1966 onwards as a result of the Doctors Charter. Health Centres were replaced by purpose built modern surgeries financed under the Cost Rent Scheme. Computers started to appear for repeat prescription and later for patient records, appointment systems and so on. Now we have all singing and all dancing computer systems linked to the NHS exchanging records and clinical letters, passing prescription orders to pharmacies. Referrals can be made on Choose and Book. Patients can interrogate web sites, look at their own records, book appointments and order own prescriptions.
All these changes need to be managed by professional and committed people. There are many skills required principally being able to deal with computers, and all the software entailed in accounts, payroll and patient record keeping. It is no longer asking patients to take a seat in the front room until the doctor calls. Yet the worry is that there are still some practices, some doctors, some nurses, some managers and their staff that have not received the message that the Care Quality Commission will be on their backs and that their practices must be run in a professional manner and that they will be accountable for the standards and the quality that exist in their practices.
Recently inspectors have asked for cleaning schedules visible for visitors to see. Managers are being asked for risk assessments if no defibrillator is provided. Practices need an emergency plan in case the place is flooded! There is always a flavour of the month that needs to be attended to – it is an ever changing picture. Be prepared and be prepared well in the motto you need to follow. Do not think it will not happen here because sadly it does.
Robert Campbell – January 2016