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Somerset Calling

Friday 8 November 2019

It wasn’t until late last Sunday evening that my post-match torpor started to wane. I’d approached the weekend in a state of anticipation and hadn’t planned much past the rugby World Cup final, which promised a brief but triumphant distraction from the assorted flora, fauna and debris fleeting past the window, borne on the sodden wings of the latest Atlantic weather system. Only later did I look at the calendar for the coming week and realise, too late, that I shouldn’t have taken the weekend off.

Every day has been rammed with practice work, meetings, or traipsing up and down the A358, and the evenings brimming with further thrills. This was no ordinary week either; we had the LMC County meeting yesterday, and on Wednesday it had been Madam Vice’s turn to play nicely with the CQC, and so I’d stepped into her elaborate shoes to attend the Clinical Executive Committee (CEC) meeting at the CCG. Between them that equated to 37 papers to read and scrutinise, as well as another five meetings I had to think about. The CEC papers alone ran to 178 pages (a late addition at the start of the meeting knocked that up to 240) and are confidential, so I can’t share any detail other than to say that the 51-page Integrated Exception Report is in itself an extraordinary mass of metrics about the Somerset system as a whole that would take an uncluttered brain a week to plough through and assimilate properly. This week, alas, mine is cluttered.

It’s increasingly hard to find gaps in the diary for meetings. Some weeks ago, we arranged an 8am meeting in Yeovil next Thursday with the CCG to start the contract negotiation process for next year. For reasons unknown to us, or indeed to the relevant CCG managers when we met for our liaison meeting yesterday, the meeting was subsequently cancelled. Between us we decided to reinstate it as the only option available for many weeks. I’ll be taking croissants, but alas not two of my senior LMC colleagues who can’t re-arrange their surgeries for a second time. They’ll be joining in for the later rounds.

A question that arose early in the week is where in ‘the system’ the overall responsibility and oversight of the Primary Care Network (PCN) development process lies? Somerset did well to identify its PCNs and Clinical Directors earlier in the year, a process that has to start on the ground in the practices themselves, and it was clearly the remit of the LMC and Somerset GP Board to support the process. We continue to nurture, and on Wednesday arranged an evening event for the CDs with Adrian Poole from Porter Dodson Solicitors, who spent a couple of hours fielding questions about the legal aspects of PCNs, and hopefully, in most instances, providing reassurance to them. The GP Board has also brought the CDs together twice to discuss how they might develop as a cohesive unit and the agreed plan is for them to form an Operational Board for Somerset Primary Health. The plan is for this Operational Board to provide links with the wider system. That’s the ‘ground up’ bit.

The CCG are the commissioners, and so inevitably have to have some ‘top down’ control over the way PCNs develop in the future, even though nearly everybody has got the message by now that their initial purpose must be to improve the resilience of local Primary Care. They are keen to help development of the PCNs and offer support, as are any number of other bodies (from the NHS and outside), but it all needs to be co-ordinated. In a meeting on Monday, I’d described it being like a stalagmite and stalactite, but that’s not right as the ‘mite’ arises from the drips off the ‘tite’, and they’ll always meet eventually (doh). Maybe a better analogy is that of the Channel Tunnel being dug from both sides of ‘La Manche’, and instead of our plucky boys surfacing in a Boulogne boulevard, while Jonny-Frenchman arrived with a beret and baguette in a Folkestone field, somebody somewhere had overall control. They didn’t end up digging two parallel tunnels, and after drilling 16 miles from either direction, the alignment was only 50 centimetres out when the two sides met in the middle. As a system we need to be clearer about the governance process to make sure all the support is complimentary, properly aligned and avoids duplication. Then all we have to do is to figure out how to plug integrated care teams and the wider neighbourhood work into the analogy. We’re working on it.

Congratulations to Dr Richard Bache of French Weir Heath Centre for being the first to email with the correct answer to my ‘Star in a reasonably priced car’ conundrum. He has since been appropriately rewarded. The answer was Dr Stephen Ladyman, currently the Chair of Somerset partnership and the Somerset System Leadership Board, who has an impressive and multifaceted CV. He was a research scientist for the MRC and an IT consultant for Pfizer, before being elected as a Labour MP, serving as a health minister and later the Minister of State for Transport in the Blair government. His ability to drive fast was evident from his lap time near the top of the leader board- faster than Jeremy Clarkson himself managed- and from the ‘prizes’ endorsed on his licence at the time.

I’ll admit a soft spot for French Weir; it may seem iniquitous to do so here- other practices are available- but hey, it’s my blog. It’s where I’m registered as a patient and always get excellent service. A month or so ago I had to get my immunisation history for our new employers. The receptionist I spoke to couldn’t have been more charming, even once she clocked that most of my inoculations against the more esoteric infections of bygone centuries would require her to dig out the ancient scrolls. She confided that nothing would give her greater pleasure than to phone me back later when they were ready to pick up, and duly did so.

The fact that three of the first five entries to my Top Gear competition came from French Weir suggests that at least some of them skim through this tosh, although I suspect it’s probably part of their proactive care programme. They’ll take it in turns to scour these lines looking for hesitation, repetition or deviation, perchance a misplaced apostrophe, as evidence of incipient cognitive decline, at which point a ‘Test Your Memory’ form will arrive on the mat.

More significantly, if it hadn’t been for their French Weir forebears, I wouldn’t be where I am today (hmm). Back in 1983, I spent two weeks- half of my total undergraduate GP training- there. The senior partner of the day was instrumental in organising the Somerset Vocational Training Scheme at the same time that Dr. Bray senior was doing the same in North Devon. They often travelled up to Bristol together and became friends, so I took advantage and asked if I could spend the second fortnight with him at the Weir.

The Medical School in Birmingham had arranged our first two weeks locally, and I was posted to a large modern red-brick edifice in Aston. They had a partner who was virtually stone-deaf and worked with a personal assistant and specially modified equipment. I’m still not sure how, or to what extent, he managed to do the job. The patients came from a wide variety of ethnic backgrounds and the vast majority of the adults, no matter what their presentation, received a fortifying vitamin B12 injection at the end of the consultation. OK- as a placebo, an injection of bright red liquid would be more effective than many of the traditional potions being dished out at the time, but I was shocked, nonetheless. By the end of my stint there, I felt that General Practice probably wasn’t for me.

The following fortnight at French Weir came as a revelation. The partners all had their distinct personalities and quirks but respected and complemented each other and had a real interest in the patients and their families, something that sounds obvious now, but hadn’t been evident in Aston. The first practice computer in Taunton (belonging to a Dr. H. Yoxall) was still four years away, and the nearest thing at French Weir at the time was an index card system on which one of the more fastidious partners recorded his patients and their conditions. I stayed with my sister and brother in law who had a farm on the outskirts of Taunton, and when not at the surgery, walked their dog and chopped wood. The scenery was green and lumpy, and I relished the country air which, unlike in the West Midlands, you couldn’t actually see. I had found my métier and developed my masterplan to become a Somerset GP, complete with accessory Labrador.

In February 1988, having already sourced the dog and Mrs. Chair, who’d preceded me round the scheme, I arrived at French Weir to spend a very happy last six months of my GP training scheme. I’ve worked there once since then. About ten years ago, after a heavy snowfall, the A38 to North Petherton was blocked. I live within half a mile of French Weir, and one of their partners equally close to my practice in Pethy. We agreed to cover at each other’s practices, trudging through the drifts to get there, and it all worked out rather well. A week or so later, I recounted the tale at the (then) PCT offices, and whilst not expecting a medal (well, not a big one) was taken aback when one of the managers’ first comments was about how many regulations we’d broken in the process.

We’re now officially in purdah, and NHS organisations have strict instructions about what they can and can’t get up to during the pre-election period. A nugget from the CCG Chief Executive at the CEC meeting was that purdah is an Urdu word meaning ‘veil’ or ‘curtain’. May I suggest we draw a purdah over the whole of December? A bloody election and then Christmas within a couple of weeks is more than I can stand.

Nick (in a post-Halloween, peri-carnival, pre-festive grump)

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