IT’S almost 16 years since I worked as a nurse in general practice. It’s work I loved; in the main I worked with those with longer term conditions both physical and emotional and we developed local services that met their needs close to home.
One of the joys of general practice is you build up relationships with people; you know, the highlights and – given the role – usually the lows of their lives; you see them sink, you see them swim. It’s an honour to be alongside people and their families through their lives. It’s physically and emotionally draining too, but very rewarding.
I moved on as I wanted fresh challenge, to use what I had learned in new terrain, to challenge myself and in time to set up and work with leading third sector organisations where I could make a difference in another way. Most of the GPs I worked with are still there. Doing the same work but in more complex times. The population is ageing and less healthy and both bring complexity. The needs of older people won’t be solved by medicine in the main, it’s good social provision that’s needed, the primary care teams as the constant in their lives feel the pressure as social care provision is stretched – it, too, is in need of new models to embrace a different future.
More than five years on from the economic crash, where we bailed out banks and allowed the poor to pay the toll, general practice teams are seeing the impact every day. When told of signs and symptoms that don’t seem to make sense, they know now to ask “are you getting enough food?” In some areas, their job has become about sending people to food banks, their fingers are in the dykes of a tide of human despair and we wonder why they don’t want to stay?
One friend who is a GP told me the reason she was voting Yes in last year’s referendum was she saw the need for change daily and she thought having power over all the things that determine health, especially welfare, might make a difference. She described it as a selfish reason, as it would make her life easier.
She, like many others, has resisted going into a GP partnership, knowing that running a business whilst doing a job like this is hardly appealing. We need new ways; my friend and colleague Dr David Reilly has developed a course called the WEL (Wellness Enhancement Learning) to support people with long-term conditions back to well-being.
It tackles the many complex factors that affect our health in modern times; it builds on what’s strong, not on what’s wrong; it builds our inner resources, it brings a fresh approach to food and helps us to understand more about how modern times impact on our health.
David also offers the course as a staff WEL, and it is evident that those working in primary care are struggling as much as their patients. We are in this crisis of well-being together, simply providing more of what we have will not change this.
We need a system-wide commitment to invest in well-being, we need new models of general practice, we need to support and to build on the health and resilience in our people and communities, we need to make integration of health and social care, work for and with communities alongside a third sector supporting community well-being and self-management approaches as true partners in the work.
We have sound learning in the system of what can help from the work with GPs at the deep end, from the WEL, the many self-management projects across Scotland, the Links worker project, the House of Care; no one approach on its own will make the shift but together they might.
But what won’t work is doing more of the same, no matter how much money we invest. The Scottish Government is supporting many of these new ways of working, as well as working on a new GP contract; the direction of travel is right.
So the time is right to ask ourselves, what is the bold thing we would do right now if success was guaranteed… then go out and make it happen. «