What comes after COVID?

Coronavirus has probably done General Practice a favour. Of course it has been hard and scary being on the front line when the entire country is in free fall trying to cope with something which reaches to the core of our society. But rarely has there been a disease which has forced the NHS to change its practice solely based on evidence and which has so swiftly and viciously punished make believe and wishful thinking. Over the last 15 years General Practice has been slowly strangling under the weight of made up targets and coercive management such that the life of an itinerant locum has seemed way nicer than the burden of being a partner. But now we have enjoyed freedom.We have been free to study the evidence and work out how to practice safely in our own setting.We have been free from odious targets which use our time and contribute little – let’s face it, have patients suffered because we have been concentrating on looking after them rather than ticking QOF boxes?We have been free to choose what is clinically important and prioritise what makes the most impact for our patients.It may be that we would have found this freedom eventually but it could well have required the privatisation of General Practice to get us out from the dead hand of bureaucracy.We now have an opportunity to shape what comes after.There are three things on which General Practice rests:Capacity to care for patients. This is why we are here.Income. We have to earn enough to attract new GPs.Job Quality. The work needs to be enjoyable and satisfying to keep staff long term.For too long the stability and strength of Primary Care has been sacrificed for short term gains. Even the Five Year Forward View and Primary Care At Scale are based on ideology and hope rather than organic growth and proven effectiveness.We must ruthlessly choose to do only those things that increase capacity, income and job qualityThis will be different for different practices.Trust, Continuity, Respect and Partnership with patients have worked well for our practice especially during COVID19 but whatever works for your practice we must all single-mindedly stop our time being wasted by irrelevance.In a resource limited health service, any new activity which does not yield more additional capacity than it uses will reduce capacity and harm patient care.

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