Rebuilding primary care — the danger of reinventing the wheel

Antony Stones is an Advanced Care Practitioner for Haxby Group in York and the ACP representative on the Humber & the Ridings RCGP Faculty Board. He also writes and performs spoken poetry.°

The current pandemic has provided an incredible catalyst for change throughout health care, however, change for change’s sake will result in upheaval for staff, confusion for patients and unnecessary investment. By developing an exit strategy early, we can ensure, to the best of our ability, that general practice is future-proofed and comes out of the current pandemic far stronger that it went in.

During this period of flux, there is a very real danger of reinventing the wheel, either by making unnecessary changes as a kneejerk response or due to multiple organisations implementing the same process using different methods — a needless duplication of work. Many surgeries have produced policies, pathways, and algorithms regarding everything from cleaning door handles to verifying death. Within each locality there are numerous bodies with an interest in ensuring the smooth running of general practice — CCGs, LMCs, and PCNs being the main three — yet each surgery or business group is developing its own procedures, often without consulting other organisations; these overarching regional bodies are in a position to orchestrate a more collaborative approach.

There is an argument that each organisation is run as a business and there are competitive interests at stake, however, if GlaxoSmithKline and Sanofi are able to work together to achieve a mutual goal should we not follow suit? By working together, and utilising the skillset and knowledge base of all staff, not just partners, geographical groups of surgeries will be able to streamline the development of new SOPs.

Even whilst we consciously avoid reinventing the wheel, we must exercise caution in the way we upgrade the car. Our starting point, prior to the pandemic, could be described as a Morris Minor; a significant improvement on the horse and cart or Model T of very few years ago, yet with considerable progress still to be made. This epidemic is an opportunity to pull together and make significant changes, regionally and nationally, to benefit the profession and our patients across both primary and secondary care. We must, however, ensure that our first step is not to bolt a Formula One engine to the Morris Minor and expect good results. We can rebuild primary care from the ground up; some parts will be kept, some renovated and some replaced, but we need to have a final vision in mind to ensure that, after all our hard work, the vehicle is robust, responsive, and future-proofed.