New Chair’s Blog:
It is a huge privilege to have been elected as Chair of Lothian LMC & GP Sub-committee. I take on the role at a difficult time when we face an unprecedented series of challenges. Growing workloads, rising costs, and increasingly inadequate funding are a perfect storm that continues to grow in strength. General Practice is remarkably adaptable and resilient but it is not invincible and cannot withstand this storm indefinitely.
As an LMC our role is to represent, support and communicate with GP practices across the Lothian health board area. The BMA Scottish GP committee is advocating for us at a national level and LMCs and practices are doing the same at a local and health board level. Our goal is to influence and shape the system so that General Practice can thrive instead of barely survive.
The pace of progress is slow and at times the best we can achieve is to reduce the rate of decline. It is a real sign of the times when ‘succes’ is the imposition of a hardship in place of a disaster. It may be a leap too far to celebrate this unique version of success but know that every inch of ground gained or lost is being fought for.
I said in my farewell speech to my predecessor Dr. Iain Morrison – “if the Titanic had never hit the iceberg none of us today would give a second thought to the competence of its Captain or the navigational abilities of its crew”. To continue the nautical metaphor I am hopeful that we can soon change course and set sail for calmer waters but for now dodging each new iceberg is a victory we should be proud of.
While it is important to understand and address the serious threats we face, it is just as important to remember that we are not passengers in this situation. As an LMC we will continue to advise practices on contractual matters and strongly recommend that practices apply the BMA Scotland safe workload guidance. The interface document shared with practices earlier this year gives additional advice on how to approach requests for un-resourced work from secondary care. We also urge practices to consider the business case for Enhanced Services. The lack of payment uplift over many years represents a significant real terms cut in income. Many of these services may now be costing practices more to provide than they bring in.
I know many colleagues find it difficult to implement the BMA workload and LMC interface guidance. I share that difficulty as it pains me deeply to inconvenience patients and appear unreasonable to respected and valued secondary care colleagues. The alternative however is to work at unsafe levels and to see our practices drift ever closer toward financial ruin. We must recognise that personally subsidising the rest of the NHS is not our responsibility.
These current tools are imperfect but they are what we have to protect ourselves and the sustainability of our practices. I believe there could be more collaborative and mutually beneficial ways forward which utilise the adaptability and efficiency of General Practice. We can be the solution to many problems but we cannot do it for nothing. I hope this is something which can be developed locally or nationally in the years ahead.
One of my ambitions as Chair is to improve communication and understanding between the LMC, practices and the public. I intend to use this blog to provide a regular overview for practices about what we are doing and to highlight important developments and decisions taken. There will be more to follow on the topic of communication to patients as I feel it is vital that we inform the public about the challenges we face together. Our patients deserve better, we deserve better, and the goal of a well-funded effective General Practice is in all our interests.
Our current trajectory has us heading at full steam straight towards an iceberg – but there is still time to change course. If we can utilise our collective talents, support each other, demonstrate our resolve (tempered by kindness and compassion), and communicate effectively, then whatever the outcome we will have left nothing on the table. The great ship ‘General Practice’ must be allowed to continue on its journey.
Dr. Andrew Forder
Chair Lothian LMC & GP Sub-committee
