View from the ground, by Dr Nick Harvey

Harvey nick

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Pressure is an expression of force exerted on a surface, divided by the area over which the force is applied. The force exerted reflects the amount of gas in a chamber, and if the lab technicians fix the temperature and volume, as the amount of gas in a chamber increases, so does the pressure.

The pressure in our primary healthcare ‘chamber’ is building, and has been for some time. The amount of work (gas) is increasing and the associated stress and inefficiencies (temperature) are also going up. So, what can we, on the ground, do about it?

We can wait for the pressure to rise to rupture point, or wait for the size of the chamber to be increased by our lab technicians (politicians and commissioners). Or we can act. Now.

We can reduce the internally generated temperature. We can reduce the stress by utilising the workforce available and by bringing efficiencies through harnessing technology. The General practice forward view has highlighted some significant areas where we can drive reform and has given us resource to do it if our CCGs allow us the freedom. I see a future where, if GPs are to survive, we must fully utilise administrative staff, nurses, paramedics, physiotherapists, mental health workers, physicians’ associates; the list goes on. This will require leadership and, on a much larger scale, people willing to be led. This is the wonderful thing about the diversity of our workforce—we all react to pressure in different ways. Some put their heads down and work hard and others try to work differently. One strategy wouldn’t work without the other. And it is working in my practice. The internally generated temperature is reducing by doing just this.

Disruptive technology (a new emerging technology that unexpectedly displaces an established one) will be next to drive efficiencies in the way we engage with our patients and clinicians. Again, this is an area of focus for us but it will take time and money.

What about the size of the chamber? Can we do anything about this? Let us not forget that we are getting more funding in primary care but many would argue it is not enough. On the ground, it feels like the trickle is so slow that the pressure reduction gives us time for a breather, but not enough to allow for transformation. We need a significant and quick injection to allow for the latter. In my locality, there is progression towards a much more collaborative approach to health and social care, with budgets being amalgamated in East Sussex Better Together (ESBT). I can see that this has the potential to drive efficiencies as it is effectively increasing the size of the chamber, but the gas inside has increased proportionally. The temperature has also spiked, resulting in an increase in pressure because of the challenges of working together in new ways. The quality of leadership and engagement is what can tackle this temperature rise, but there is no simple formula for this.

We are in a unique position as GPs where, if we unite, we can also be the scientist that understands what is happening in our chamber. We can try to influence the lab technicians that are tinkering. We also need to understand their observations and engage with them. It may not help solve the problems but if we don’t try we only have ourselves to blame.

My message, then, from the ground, is that I think we have a once-in-a-career opportunity to shape the way healthcare is delivered. I am optimistic but it will take many clinicians stepping up to lead and invest in their own learning to do this well. It will take even more clinicians to actively support local leaders, both by trudging on in their day job but also by accepting change and engaging in dialogue with their local and national leads.