If you take the work of Steve Peters (of “The Chimp Paradox” fame) seriously, which I do, then you can see Chimps at work everywhere in the NHS right now (and I’m not taking a cheap shot at Jeremy Hunt). For those of you, who have no idea what I’m talking about, then do read the book….but a brief precis is this: each of us are two people – we are both simultaneously an emotionally driven, primal chimp and a more rational human being. When faced with difficult circumstances, our chimps all too easily take over and our behaviour is driven by our emotions, because our human also feels insecure and we lose hold of our values (the computer part of our brains) which is able to alter our chimp behaviour.
I’m not making a judgmental criticism, I see it in myself. I see the raw emotion of how I feel about what is happening in General Practice, Community Nursing/Therapy and indeed the NHS at large and it becomes easy to function out of raw emotion, heading into ‘rant mode’ or a strong defensive posture with the rest of my pride. But I have found it brings division. It pits my practice against another or General Practice at scale against the Hospital Trust or the government or whoever. But it doesn’t actually solve anything. It stares the problem in the face and hollers at it or throws faeces at it, and other than being cathartic (which has it’s place for a while), it doesn’t engage with a creative or collaborative process about how we face the future. The facts are right in front of us, and there is some thought about how to make General Practice strong enough to survive, be that through giant mergers or the formation of federations. Here in Morecambe Bay, we are experimenting with both those options and also trying to work in Integrated Care Communities (incorporating all our community partners) according to geographical locations.
However, I’m not sure we are facing up to the realities we see creatively enough. Whether we like it or not, General Practice as we have known it is unsustainable. There simply aren’t enough doctors coming through training, there aren’t enough doctors choosing to be GPs and there certainly aren’t enough GP trainees wanting to become partners.The partnership model as we have known it, is over, and the sooner we face up to this, the more creative energy we will be able to harness to find solutions. The formation of federations or the advent of the ‘super-practice’ will go some way to stop the gap, but it is the structuring of them that deserves some attention. Integrated working with community teams, be that district nursing, mental health, community therapies or social services calls for a wider and deeper system change. But here is the very difficult thing for GPs to let go of: the idea of the autonomous self, being in charge.
If we are going to find solutions to the needs of the people we serve and develop together (no matter what is being shaped from the centre) a future healthcare model that works, GPs may need to let go of our power, as we have known it and embrace a different way of being. I think a possible solution lies with the co-operative movement as this would allow a truly integrative model to develop that benefits all our workers, no matter what their role, giving us the cultural environment in which innovation, excellence, learning, creativity and compassion could really flourish. Due to the nature of co-operatives and the principles at their core, a powerful force could be released which provides alternative solutions for a more equitable society.
What would a co-operative model be like? Well, there are different options and different styles, from John Lewis to Mondragon, or the model adopted by Jos de Blok in the Netherlands. But the reason I like it so much, is that it takes power from the few and shares it with the many. It allows for a different style of leadership and a different mode of making decisions. Collaborative conversations and compassionate care of one another in providing care to the wider community becomes the order of the day with leadership that is both clinical and managerial but modeled on financial benefits for everybody and cooperation of wider teams of people.
There are draw backs and co-operatives are not perfect, but they are a solution that should be seriously considered as General Practice tries to navigate itself into the future. They can be complex to set up, but I would argue that complexity is worth it when it offers a solution that lasts longer than a more straight forward quick-fix that may not make it past a decade or two. Are we brave enough to explore solutions that dis-empower us for the sake of a better future for everyone?