Yuval Noah Harari, in his book Homo Sapiens, makes a simple but crucial point about how our species has achieved pre-eminence: we have been able to extend the dominance of the imagined, the unreal and the virtual over the world of real things. Or as he put it when explaining religion, business and the rise of money: “Telling effective stories is not easy. The difficulty lies not in telling the story but convincing everyone else to believe it.”
The NHS of course is currently engaged in telling one of the most complicated stories in its history and believing it – and making it real – requires us all to drink a potent tasting cocktail of faith, commitment, and incentivisation. And why not? Drinking and storytelling have always gone hand in hand.
The latest chapter in the NHS story is the new Five Year GP Contract Framework, which has an array of fascinating characters (some old, such as QOF, and some new such as the Personalised Care Adjustment) and a series of interweaving plotlines. The most important of these plotlines is how to solve the workforce problem through effectively bringing primary care and community services together – or to use the language of the framework “dissolving the historic divide”, a phrase of almost Churchillian proportions.
This is hugely important as redefining roles and responsibilities at what we currently call the primary care and community levels provides the practical impetus for change. This heroic role is given to the new Clinical Director for each PCN who is tasked with “strategic and clinical leadership to help support change across primary and community health services”. As we know in all great stories, the hero usually has some magic weapon or power; but in this case there is no enchanted sword to wield although there is the magic mirror of Digital First Primary Care. This will however be both a boon and a burden; making it work will require a significant amount of leadership and marketing.
The Clinical Director’s Role will be an extremely powerful one. Leadership will be both clinical and strategic, and she or he will be (in very real terms) the accountable person in matters of local governance. But they will also have an important brokerage role upwards; the phrase “Practice rights, plus CCG obligations” has a busy ring to it.
There is a lot more in this eminently sensible document. Long term funding, test-bed reviews of new interventions, specific descriptions of the roles of pharmacists and physiotherapists. The details of this contract, when available, will be picked over endlessly, and quite rightly. The pension provisions, the pound per head of population payments, every conceivable line and byline.
But, at the end of the day, the narrative is a believable one, and this story has one very simple message for GPs and the professionals working with them: deliver for your community and the NHS will deliver for you. As a practising GP, working in a multi-professional environment, I’ll drink to that. In moderation of course.
Dr Claire Fuller