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Lines of Duty

Friday 7 December 2018

At last ‘dateline blog’ I was in London and about to set off up the river to the English LMC’s Conference. The LMCs from the peninsula had met up the previous evening in Blackfriars for a bonding curry, and Barry and I found ourselves sharing a table with Devon’s vice-chair and Bob Fancy, their recently appointed Operations Officer. Bob proved an entertaining dinner companion and wasn’t at all fazed by the apparent lack of space on our titchy table for the standard curry paraphernalia and four large flagons of lager, being as he was an ex-submarine commander. He would seem perfectly placed to cope with the latest NHS England obsession with ‘deep dives’ into everything. He tells us there are fewer submarine captains in the world than there are astronauts, and I would venture that they have a fairly unique point of view on everything, and in every sense. It’s no surprise that they’re very much team players- either the whole crew comes to the surface or none of them do. It’s going to be fascinating to see how he gets on navigating the murky depths of the NHS. It also throws into some sort of perspective the concept of ‘risk’ in our respective trades. He has stories.

The conference itself was brilliantly chaired by a couple of our younger female GP colleagues and for much of the time, the entire top table consisting of the Chair, secretariat of the BMA and relevant Chairs of the individual GPC committees were all women- something that didn’t escape the attention of the watching media. Well done us. There were some highlights from the podium: Richard Vautrey received the traditional standing ovation after his ‘State of the Nation’ address, but the most prolonged and up-standing applause was reserved for one of my LMC chair colleagues from the Home Counties. He had got up to speak in support of a motion censuring the present performance review arrangements, having had a complaint earlier in the year that had gone ‘rogue’. He is a regular performer at conference, but was suddenly overcome trying to recount what had happened in his case. Delegates are allowed a strict two minutes to make their points, but the Chair quietly stopped and reset the clock as 400 delegates and observers willed him to find the words to finish his address. It was a powerful and poignant moment- and evidence of just how devastating and life-stopping the effects of complaints and the performance process can be on even the most experienced and battle-hardened colleagues. I suspect we all had a little something in our eyes at that point.

I was ready to leap into action to pan Pharmacy2U, but not called to speak, and the only one of us who did get to the podium was Barry- suitably trousered- who not only proposed but managed to get passed a motion proposing an incentive scheme to retain older GPs. It looked and sounded remarkably similar to the old scheme, providing the older lags with extra folding readies on the basis of the number of years they’ve survived in the NHS Vale of Tears. His cause was helped significantly by a colleague from Kent who not so much spoke in support, but rather spent one of his two minutes singing ‘When I’m 54’ (sic). Anyway- it’s now GPC policy so let’s see where they get with that. We’ve heard this week that we have until January 8th to get motions in for the LMC UK-wide conference being held in Belfast in March. I can’t think of anything vaguely interesting happening around Northern Ireland at that time- but just hope and pray that the word ‘backstop’ doesn’t appear anywhere on the agenda. What will be on the agenda, I’m sure, is the new state-backed indemnity scheme for GPs which is due to start next April. News came through on the eve of the conference that the government expects this to be funded from existing NHS budgets-causing consternation and anger amongst the gathering LMCs and an emergency motion condemning this position that was passed at the end of the day.

Last week, I was at Fresh Looks, except for the day when we couldn’t get a locum (guess where most of them were?) and so had to be back toiling at the coal face. The most important session for me was one on Child Exploitation, led by a Social Worker from Yeovil, Lisa Hooper, who updated us on ‘County Lines’. I’d first heard the term a little over two years ago in one of our regular meetings with the Director of Public Health, but the situation has obviously developed in quite a sinister way since then. ‘County Lines’ refers to a common modus operandi of drug-dealing gangs from the larger cities, who move down to more rural areas, often taking over the homes of vulnerable subjects (‘cuckooing’), and enrolling older local teenagers by plying them with money or drugs, who then act as recruiting agents to ensnare younger teenagers to do the running and selling of their wares. The gang leaders will often arrange to have the younger members mugged and robbed of the drugs so they then become indebted to their seniors, and deeper involved in criminal activity. It can also result in the girls (particularly) being forced into sexual exploitation to ‘repay’ the debt.

It’s a growing problem locally. Yeovil now has at least five ‘County Line’ operations, and a gang that has moved down recently from Liverpool is said to be particularly violent, leading to a surge in knife crime. Chard has two gangs and virtually all the larger towns in Somerset are caught up in this, with about 1,000 children across the county thought to be involved. That is quite terrifying, but did cast a new light on a couple of consultations that I’d had in the past week or so with worried parents. The police have responded with ‘Operation Topaz’, which has all of three police officers, but professionals can find a link to report their concerns at  . Shutting down or disrupting a local ‘line’ gang means they’ll surely just move somewhere else and so police and social services try to liaise across boundaries, but Lisa has been so concerned about the lack of resources to tackle this serious problem, especially in the face of significant local authority cuts, that she is in the process of setting up a charity. At least one of my senior colleagues was sufficiently concerned to approach her after the talk seeking to make a significant donation to the cause.

After a couple of fallow weeks, my diary has been full-on bonkers again this week with no fewer than 10 meetings shoe-horned into it the spaces between duty days, sorting out a flat tyre and some doggie-Tinder action for our broody Labrador. Amongst the usual heap of Strategy Review, Federation, practice and LMC/CCG/PHSE meetings, I found myself at Woodlands Castle on Tuesday evening to discuss a new scheme that involves inviting all our GPs aged 50 or older to a semi-structured interview to discover their hopes/aspirations/fears for the remainder of their careers. The idea is to identify GP ‘Champion Interviewers’ to perform the interview and then provide signposting/support to help their peers in a variety of areas that might ease them through the final years of work. I assume I was there to wave an LMC flag rather than as a potential ‘champion’- the room was full of experienced and clever educators and appraisers, and our Executive Director made it abundantly clear to me at the end of the evening, quietly but firmly, that she thought me far too gloomy to be let loose talking to colleagues who might be eyeing the door.

Martyn Hughes ensured the evening had a generally positive vibe for us oldies, the food was soft if not actually liquidised, and we were all home in time for cocoa and a twilight social care visit. The scheme is funded by GP Resilience money from NHSE, and they clearly hope that this will provide support to keep the greyer folk in harness for a while longer. Common themes (we could probably write them now) will be passed to NHSE to inform further workforce development. More on this soon.

A few of us met in Bridgwater on Wednesday to talk about how we could develop the Urgent Treatment Centre (UTC) that is to be piloted there, starting operation in early 2019. UTCs are the brainchild of NHS England and are mandated to be GP-led (however you interpret that), with diagnostics (including X-rays) and open at least 8-8, 365 days a year. There are likely to be between four and seven in Somerset eventually. It’s important that this isn’t just another “lane on the highway”, and we believe should offer some tangible benefit and something new to the system. We discussed clinical scenarios that might benefit from such a service, but need reassurance about their funding, workforce implications and quite a lot more. It’s always best to come up with our own ideas of what might work rather than having something imposed on us from on high. I’ll keep you updated.

I’m rounding off a hectic week with a trip to Saltash for one of our regular southwest LMCs/CCGs/NHS England meetings. It’s a foul day and the motorway will be grim, but what I’m looking forward to most is catching up with LMC colleagues over a Waitrose coffee and croissant for 30 minutes or so beforehand. Who knows what we’ll talk about? Payments for childhood immunisations? Memorandums of Understanding for delegation of commissioning functions to CCGs? Or will we have to make do with tales of playing cat-and-mouse with a Russian Alpha class sub in the Northern Atlantic depths?

Run silent, run deep.


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