It seems like lots of people know how to “fix” General Practice They know that units of 5-10k customers are inefficient and should be merged They know that uniformity and standardisation are the key to providing quality They know that big businesses are better than small businesses because they can afford better everything They know that hiring in strong managers and diligently using performance incentives keeps workers on track They know that they can leverage the workforce in primary care to make huge savings in hospitals The problem is that what “They” know doesn’t really work in General Practice Patients are not Mars Bars. They each have a different constellation of wants and needs Clinicians are not robots. They too have different skills and desires The Practices that glue them together provide unique local environments which work because they allow themselves to respond to these differences. And Primary Care is not just a gatekeeper for Secondary care – it is the destination where most care occurs. But these unique businesses still need to be well run and well ledThe Leaders need to be able to tell the story of the practice: the reason why it exists and how it will bring its unique advantages to provide the best care for its patients.They need to assemble a brilliant team of people to help themThey need to bring their patients with them and turn them from consumers into partnersThey need to navigate through the minefield of perverse incentives choosing those which help their goals, taking easy money when it is offered and avoiding plain bonkers ideas which waste their time.GP practices are more like Start-Ups than Big CompaniesThey have immediate accountabilityThey can make changes without getting agreement from othersThey know their patients and their staff wellThey are based on trust and relationshipsThey allow staff to multifunction and use their diverse talentsThey exist in an environment of uncertainty – often inflicted by the NHS hierarchyAnd what they need is Entrepreneurs to lead themBut who trains the GP Entrepreneurs to run these Start-Ups?GP registrars are taught how to treat patients but are they taught how to run a practice?Do they know how to hire people? How to fire people? How to negotiate deals?Can they enthuse and motivate and train their staff?Are they able to spot their advantages and work out how to use them?Have they the courage to lead their practice forward against opposition?There are training schemes run by the RCGP and by NHS Clinical Entrepreneurs but these are largely for people who want to branch out into something which isn’t core General PracticeIt is up to us to work out what to do and do itOnly GPs know what we really do and what pressures we faceThis is about looking after our patients really well and building great practices we will enjoy working in long termLearning on the job is fine but things are changing so fast we need to tap into the huge pool of ideas and talent in our local practicesOne solution is that GPs who run (or want to run) local practices could meet together to learn and to share ideas. We can talk about the problems we face and what is important to us – not what other people think we should be talking aboutThe only requirement would be that you are actually running a practice or that you are a partner, salaried GP or GP registrar who wants to get involved in running a practice.
