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Le football est venu à la domicile…

Friday 20 July 2018

It’s been quite a fortnight. When I nurdled the last blog into the ether, Jeremy Hunt was still Health Secretary, David Davies the lampooned and beleaguered Brexit Bulldog, Roger Federer was cruising serenely and inevitably towards yet another Wimbledon title, and everything in the garden had turned crispy brown. Two weeks later, and the countryside still looks more Gobi Desert than Somerset, but football has had a better offer and so no longer coming home, we’re being encouraged to adopt the brace position for a no-deal Brexit, and our Jezza is now Foreign Secretary. Cripes.

How will history judge Jeremy Hunt? He lasted longer than any of his predecessors in the role- serving nearly six years as Health Secretary, which if nothing else shows a degree of resilience. I met a Surrey GP at the Hay Festival some years ago who claimed to have his ear on GP matters. I had just arrived from the LMC Conference and having overheard Mrs Chair and I talking about him in less than glowing terms, she turned around and announced herself as a family friend of his. We had an animated but friendly conversation which ended with her giving me her email details, so that I could get in touch if I felt he’d made a Horlicks of anything GP-related in the future. It wasn’t more than a week or so before he’d made a pronouncement suggesting proactive annual GP visits to all our elderly patients- that made it clear he had no idea of the realities of life in Primary Care. I duly dispatched an email and 72 months later am still waiting for a reply. I’m starting to think General Practice must be rather different in leafy Surrey, or at least they seem to have much slower internet connections than us.

Jezza took over from Andrew Lansley, who left behind the wreckage of his reforms which were not only hugely unpopular with the profession but have continued to cause carnage in the NHS and wider health and care system ever since, if not yet leading to wholescale privatisation on the NHS, a commonly-voiced fear at the time. A consummate politician, he was rarely ruffled during interviews, despite the majority of the profession screaming the other way down their radios. As he left the Department of Health, he admitted on Twitter that “staff haven’t found me the easiest health secretary”, but he said that the NHS, and in particular patient safety, had become his passion and it had been the greatest privilege of his life to serve for so many years. In his new role, just a few days later he had the ‘privilege’ of hosting President Tango for a slap-up supper at Blenheim Palace. He hasn’t tweeted since, possibly because he can’t find the words, and I would hope we’re still in top privilege spot.

I mentioned at the GP Board this week that I thought he’d changed his manner and approach after so long in the job. There were stifled snorts from around the table, but I’ll stand by that. That’s not to say I agreed with most of what he said or did. Following the publication of the Francis report, he championed patient safety and brought in safe staffing policies, with the result that many trusts had to pay a fortune to agencies to meet the required staffing levels. His dogmatic approach to the manifesto pledge of 7-day working and approach to the junior doctors’ dispute earned him few friends in the profession. More recently he’s admitted that he got the workforce planning wrong- something many of us spotted years ago. Last year he resisted being reshuffled to what was bound to have been an easier brief as he felt he still had work to do, and picked up the Social Care chalice as well. He was credited for securing extra funding from the Chancellor earlier this year when most other departments were facing cuts. He was on the right side of the Bawa-Garba dispute, and I astonished myself by nodding furiously as he spoke on Today to defend the right of doctors to speak freely and learn from mistakes. He leaves the NHS at a critical stage and some would say teetering on the brink, with a workforce crisis and increasing evidence that clinical standards are starting to deteriorate in some key areas. Who’s lined up to take this hospital pass?

In his place we have Matt Hancock, so at least we’ve still got some comical nominal potential, should we feel the need to be childish in the future. I had to look him up; He’s 39, was previously secretary of state for digital, culture, media and sport, and has had no prior experience of working in Health or Social Care at any stage in his career, although his wife is a part-time osteopath, so that might be helpful, I suppose. His family has a background in IT, and he was writing code for the business whilst still at school, which implies a certain sort of brain, perhaps. He tweeted yesterday that he was finalising his first speech and setting out his early priorities as “1. Workforce, 2. Technology and 3. Prevention”. One of our local CCG colleagues replied that maybe patients should be in there as a priority as well?

We spent a considerable chunk of our GP Board meeting on Wednesday discussing communication- both between the Board and other health bodies, but more importantly with our local GPs and practices. Every organisation, be it the CCG, Somerset Primary Health, the Trusts, LMC or whoever else, seems to struggle to get the communication right. We must avoid swamping busy clinicians with too much stuff, especially if not obviously relevant, whilst at the same time keeping them informed in a way that stimulates interest and engagement. It’s a continuing source of irritation to me that the links in the CCG’s GP Bulletin can only be opened on NHS computers. Often at meetings we hear about something that has gone out from the CCG and should have been received and acted on by practices ‘because it was in the GP Bulletin’. For (what is now) literally years, we’ve made the point that GPs have no time to read anything they don’t have to when they are sitting at their desks. Despite assurances last year that the necessary tweak to the system was imminent to allow documents to be read on non-NHS computers, still nothing has changed, except that there is now even less text in the bulletin to advise what any particular link might be about. I’m not sorry if that sounds a bit ranty. We understand that the new Chief Operating Officer at the CCG, who takes up his post at the beginning of August has communications in his remit, so there’s an early challenge for him.

How do you or your practices feel about communications from the LMC or GP Board? We hear that many people still feel largely ignorant of what the GP Board is up to. What could we do to improve how we stay in touch? Obviously, the exec team feel we’ve got the balance about right, or we’d have changed it by now. The LMC weekly update that’s sent out by email on Friday lunchtime contains information on most of the hot topics, and after each monthly GP Board meeting, that edition (as today) will contain a short paragraph about the main business that’s been discussed there. There is also the excellent LMC website and App, along with the Twitter feeds of the LMC, the Somerset GP Education Trust (SGPET) and GPinSomerset, all of which are well worth a follow.

The LMC is often asked to distribute information on behalf of other organisations, not least because we know that practices tend to read stuff that comes out from the office, and we also have more up-to-date records of contact details for practices and individual clinicians. We are rightly cautious about acceding to many of these requests. We need to maintain our independence, and whilst recognising that we can facilitate communication, we will always direct any queries/comments back to the originating organisation. Whilst we are not going to agree to distribute anything that would manifestly not be in the interests of our members, assistance with distribution should not necessarily infer full LMC approval.

I spent last weekend at the Air Tattoo in Fairford, celebrating 100 years of the RAF. Last year I’d been for the Sunday but needed more of a kerosene-fix this year, and so attended all three days of displays, staying in our motorhome next to the airfield. My companion was a good family friend, previously himself a senior RAF officer and their top (OK, only) neurologist, who now works in the NHS on the south coast. He was suffering from benign positional vertigo when he arrived, and we ticked a few CPD boxes discussing this over the weekend. A few learning points: Epley manoeuvres are not recommended if you wish to keep your confined living quarters a vomit-free zone, Brandt Daroff exercises work just fine, but following fast jets as they whizz backwards and forwards above you may not be the best therapeutic approach. A randomised cross-over trial of Rioja and St Austell Tribute was inconclusive, further studies will be needed etc. etc. The displays themselves were spectacular, and there were plenty of opportunities to watch the amazing F-35 Lightning in action, as well as get up close and personal with the latest drones and other hardware.

I went along to another Clinical Executive Committee meeting at the CCG last week. It’s frustrating that the terms of reference make clear that the agenda and papers are confidential (for now at least), although we are promised that a brief that can be circulated will be produced after the meetings. I’d be happier showing you my snaps of the F-35 doing extraordinary things and close-up pics of a Reaper drone than divulging the agenda and papers from the CEC meeting. It’s no secret, however, that it was the day of the England-Croatia semi- final, and at least one of the CCG managers present was sporting a Southgatesque waistcoat, as it was clearly coming home.

Except it didn’t. Never mind- Edward III had a far better claim to the French throne than his Valois cousins, so perhaps we can all pretend to be a little bit French and bask in some mutual back-slapping. At least until March 29th, 2019.

Mon Dieu,

Nicolas

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