Abandoning “primary care” and “secondary care”

Abandoning “primary care” and “secondary care”
Today I suggested this to a room largely full of GPs

No rocks were hurled
The context was one of language defining reality and the primary care” vs “secondary care” mindset (in my view) simply deepens silos, perpetuates separateness and doesn’t help us move towards population and place based systems.
Someone asked me afterwards whether I really meant what I said, a little incredulous. That we needed more money in General Practice – ie moving up from the parlous level of 8% of NHS spend (for 90% of contact). 

So…..I’d thought I’d better explain.

 I’d definitely support increased funding for general practice – but it can only come from within the existing NHS budget, as there’s no new cash etc.
GPs (and generalists more broadly) are by and large 1) the place where risk gets efficiently managed with minimal resources with mostly excellent results and 2) where specialists ask for help from when they get stuck as the patient has got more than one thing wrong with them etc.
Heresy point – it might not be general practice per se (workforce supply issues, skill mix issues, different models of thinking issues). But I still think there is an urgent need to reconsider the generalist / specialist split. 
So it might not be GPs, but a mix of different sorts of generalists, medics and non medics. Why stop there – go upstream and involve those who are expert in addressing behavioural issues and social determinant issues.
Transactional change = doing the job better. We are probably beyond simple improvement now (thought there is huge gain to be had from simple application of qi methods to improve outcomes at population scale)

But we still should transform. This = fundamentally redefining the job, then doing that better.
So, back to my main point, we SHOULD abolish the terms “primary care” and “secondary care”. It detracts from making population focused, place based care, and I feel it perpetuates silos and institutions / separateness. 

And you can very readily apply social care to this. Issues are the same, organisational issues and funding make a little more complex, but still……..
Language defines reality so says @muirgray

This was what I meant.


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