To all my erstwhile CD colleagues: I want you to know that I feel your pain. I do, I do.
We are currently being herded into integrated neighbourhood teams and primary care provider Collaboratives, asked to form shadow organisations for… well, who knows what, exactly. Could we be lucky enough to find a shiny single neighbourhood provider (SNP) contract tucked into our Christmas stockings? Or perhaps just the outline of one — handwritten in biro on the back of a napkin?
Depending on how grim it turns out to be, I suggest we have a side bet on when it’ll be released. If it's really bad, I’m calling Christmas Eve at 16:55.
In the meantime, I’m writing Christmas cards to absolutely everyone not nailed down — just in case I need to form a strategic partnership with them at a moment’s notice. Fa-la-la-la-la, etc. I could really use a break from all the left shift negotiations, MNP/SNP contract speculation, and existential dread around GMS contract reform.
Let’s also not forget the ever-growing cast of thousands now apparently able to influence our core GP contract. What joy. There is nothing quite like watching people who don’t work in primary care trying to extract more from us at a lower rate — it's like a party trick at this point.
At present, I’m mostly managing demand. For, well, everyone in the system. I’ve already received the annual round-robin Christmas emails from the acute trust reminding us not to send patients to hospital ‘unless they really need to be there’. Thank goodness they reminded me how to practice medicine — for a moment there I was sending people up for a laugh. Phew.
Last Saturday was our PCN Christmas party — conveniently scheduled the day after the GP Awards. Two major highlights of my social calendar. I was dancing with the award winners, posing for photos with people I’d never met and others I’d known for years. Honestly, it's nice to find the joy in this job again. These events remind me of the incredible work happening up and down the country — and give me a moment to reflect on my own.
But no surprise: I’m under pressure to scale back the community work we’ve been doing and redirect funding toward access. We're short on money, stretched on capacity, and drowning in eConsults. So yes, I understand why practices need me to use what little funding we have to prop up the frontline. But it breaks my heart to even consider decommissioning our wonderful lifestyle medicine team or reduce our mental health support for young people — just because Wes & co. have decreed that I must respond to an ingrown toenail within 24 hours. It makes a mockery of the proactive, complex care we could be delivering instead of firefighting hundreds of eConsults — complete with high-res photos of mild eczema and curious rashes.
Speaking of which — in the spirit of Christmas — I was wondering if we might ask patients submitting photos in the run-up to the holidays to include a festive object in the frame to cheer us up. A bauble, a mince pie, perhaps a novelty reindeer? (We could extend the offer to Eid, Diwali, Hanukkah, etc. depending on your faith/cultural preferences.)
I only say this because one of my patients recently sent me a photo of their sputum.
It really would have been nicer with a bit of tinsel in shot.
Just a thought.
Dr Sian Stanley is clinical director of Stort Valley and Villages PCN, East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire. Read more of her articles here.