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Should have been a vet?

Thursday 13 April 2017

This week, I've mainly been herding cats, lining up ducks and identifying elephants. Unless you've been living under a rock for the past year, you'll have heard a lot of talk about the STP, but the chances are that you probably wouldn't choose it as your specialist subject if suddenly roped in as a last minute replacement for Mastermind. Don't beat yourself up about it too much though, as I've yet to meet anybody who can give a convincing and uncluttered description of the structure and governance from beginning to end. I did once have it explained to me by a colleague with considerable confidence and brio, until we discovered that his version was a few months out of date, and that I'd just come from a meeting of a new group that didn't appear anywhere on his crib sheet. The complexity of the process has now become a problem in its own right.

The engagement of Primary Care from across the county in any new structure or collaborative process was always going to be fraught with problems. The Foundation Trusts and the Local Authority will always want to deal with a single voice from Primary Care, but we all know this is well nigh impossible. 72 practices in varying states of vibrancy and security, urban and rural, big and small, PMS, GMS, APMS, dispensing or not, some already integrating with different acute trusts, are always going to be difficult to corale. Not that we'd necessarily want to; our practices have developed their own cultures and histories over many decades, but there are areas in which we need to present as united a view as possible. Where are our red lines for engagement in any new integrated structures for example?

Last Thursday was spent in a variety of smaller meetings, several of which also involved SPH and Rosie Benneyworth, the STP Primary Care advisor, mainly working towards getting our ducks into some sort of cohesive phalanx. We also met with the Chief Execs of the FTs, and had very frank and candid discussions amongst the group, after which I think we all felt a lot better. There is more to be done defining and developing the relationship (and boundaries) between SPH and the LMC in areas where this is appropriate, and we are clearing diaries for an exciting away-day soon, with the aim of delivering something informative and bitingly relevant for the SPH AGM meeting. At one stage, I dragged our former leader, Madam Previous Chair, into a quiet corner at Dillington to chew the cud about life and the universe, but within minutes there were more previous Chairs and leads from other NHS organisations emerging from every door to join the group. It was a bit like a Brian Rix farce, except we probably laughed more, and all kept our trousers on.

Smaller meetings certainly allow for better engagement and openness. Earlier this week Karen and I met with the Clinical Directors of Taunton and Yeovil with Kevin Hudson of the RMC at the CCG to discuss the problems arising from the Procedures of Limited Clinical Value process. There are obviously difficulties experienced from both sides, and it was good to air our concerns and dispel a few myths. There are currently 60 procedures that come into the "Criteria Based", or "Prior Approval" categories, with the threat that their might be more in the future. Clearly it's impossible for any of us to keep up with all this without adequate IT support. The Navigator app is being left to whither, and we told them that without rapid development of the proposed alternative (EMIS Select), which creates a ready-populated form or advice sheet that pops up on the desktop when the relevant diagnosis is entered by the clinician, it's effectively dead in the water. We have been promised rapid action and should at least hear about the proposed timeframe in the next fortnight.

Yesterday morning saw the publication of the survey carried out by researchers in Exeter which revealed that 40% of GPs in the Southwest were planning to retire in the next 5 years, stressing the low morale and mountainous workloads we are all too familiar with. No surprises for any of us there, but it set off something of a media feeding-frenzy. I was called on Tuesday afternoon to arrange a live interview for BBC Somerset at just after 7am yesterday. They usually phone the day before and tell you when and how they want to do the interview- FaceTime is their favoured medium. For live radio interviews I like to have a big piece of paper with some key points that I'm keen to get across scribbled on it, but most importantly the letters S-L-O-W writ large across the top as I have a tendency to gabble if I get excited/nervous/angry. ITV news phoned at lunchtime, and then dispatched a man in a van with a big camera and a fluffy mike to grab some footage before my afternoon surgery. He had been given a vague idea of what the reporter back in Bristol wanted to cover and so just asked me to talk on several key points, that they would then edit their questions into afterwards- which can feel a bit disconcerting. By then, I had several interesting clinical problems things starting to bubble, and was looking less then shevelled, but frankly past caring.

Do you ever question your career choice? I was having a rare sulky grump on the way to a visit that had been requested in the early afternoon when I heard the news about the chemical attack in Syria. I had been driving through some lovely countryside in the spring sunshine and musing the most appropriate way to vent my spleen, when I heard a reporter on the radio say something about children foaming at the mouth, and medics spraying them with water. I recalled meeting a lovely young Aussie medic whilst cycling in Vietnam last year, who had appalled her family by announcing that she was determined to join MSF and head to work in Syria. As I parked, the story developed further with the news that the Russians had bombed the hospital where the victims of the attack had been taken, supposedly to destroy the evidence. Suddenly the intricacies of trying to resolve Improved Access, the organisational form of the Accountable Provider Organisation, disentangling all the acronyms and the rest of it seemed like a walk in the park.

Later that evening I was at the Medical Club where the speaker was a local vet, who also happens to be one of my patients. I know him as the chap who worms and jabs my dog, but I didn't realise was also an expert veterinary anaesthetist. I always have an admiration for vets of my vintage who suffered from the Herriot effect and needed 3 A's to get in vetinary college, whilst 3 C's and a decent drop-kick would get you into a London medical school. He does work for Bristol Zoo amongst other places and talked about the challenges of anaesthetising all sorts of poorly fauna, including fish, parrots and gorillas. Next time you find yourself with your knees either side of the Resusci-Annie doll squinting for the vocal cords, consider the challenges on anaesthetising an anteater, 40 kg of tapering snout and vicious claws, with a 14-inch tongue to negotiate, whilst it does its best to disembowel you with its front undercarriage.

All in all, despite everything, there's much to commend being a GP in Somerset.

Happy Easter,

Nick Bray


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