Policy Bite: A brief note on election day…

Prof Amanda Howe, President-elect, writes:

Today my country goes to the polls. We have had a coalition government for five years, and may end up with another. During the last government, we had a major health service reform, with a new ‘market’ model where more services could be contracted with private providers; family medicine doctors were tasked to manage the budget to buy services from the hospital and referral centres: and large scale reorganisation occurred, within the context of a taxation funded public health service. In the last five years, we have also seen a slide in budget in the family medicine sector from 11% to less than 8%; a recruitment crisis, with fewer young doctors choosing general practice as their preferred career: and many doctors choosing to retire early or move abroad.

Many people are surprised by this – they wonder why this is happening, when it looks like the UK family medicine sector is so strong, well respected and embedded in a health system that is deemed very effective. There seem to be three reasons – lack of resources following patients into the community where most of them receive most of their care; uncertainty about the career structures and reimbursement for family doctors in the current rapidly changing situation; and a very high workload with complex demand.

The challenges we need to meet as family doctors include the fact that :

- We are often a new speciality, trying to establish ourselves against tradition and expectation

- We are particularly close to our patients and communities, so the sense of emotional involvement and responsibility can be greater, and more demanding

- We have to gain and retain a very broad range of knowledge and skills because we are generalists

- We often work in relatively small teams, which mean we are very dependent on each other

- And we have the challenges of dispersed units – physical infrastructure, securing resources & staff, robust technology including internet access, & maintaining professional standards.

In order to reduce unnecessary workload and use our resources effectively, we need to:

- Minimise time spent on bureaucratic aspects of care (governance, payment claims, data recording and reporting). We must of course provide safe care and show proofs of our work. But I was horrified by an article from the USA listing the 15 major challenges for US physicians , all of which were about financing and recording issues!

- Build capacity and retain staff – we need enough staff of the right skills and competency to deliver a fully comprehensive primary care service for the patients in a community. This requires securing of health system commitment for the medium and long term to training of family doctors, community nurses, and support staff for administrative and heath care services. And that needs political commitment to financing of training both in university and healthcare settings. It also needs appropriate career development and payment / reimbursement structures that reward and retain staff in primary care, rather than encouraging drift back into urban centres or private practice.

- We also need to make really strong political alliances which promote the profile of family medicine.

- The final political challenges are having the evidence to support our work, and being seen to deliver on our promises. It is interesting how often even a strong political initiative can be weakened both by lack of evaluation and evidence on outcomes, and also by a negative example or low quality deliverable in a small part of the sector which becomes a media scandal or a means by which another powerful group can undermine the cause of family medicine. So we have to be effective at both doing our jobs well and collecting data to prove our effectiveness – or to identify areas where we could do better if further resourced.

In order to turn this around, we have been campaigning to secure more resources, and now anxiously await the outcome of the election to see if promised resources will follow. Let’s see what happens next!

Amanda Howe