Intended for healthcare professionals

Opinion Primary Colour

Helen Salisbury: A cool welcome for management consultants

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1975 (Published 29 August 2023) Cite this as: BMJ 2023;382:p1975
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}phc.ox.ac.uk
    Follow Helen on Twitter: @HelenRSalisbury

General practice is in crisis, and clearly something must be done. Funding has shrunk from 11% of the NHS budget in 2006-07 to less than 8% now; the patient population has grown, but the number of GPs available to look after them has fallen by 2133 since 2015.12 Unsurprisingly, patients are finding it hard to see their doctor. But rather than these funding and staff retention issues being tackled it seems that reorganisation is on the horizon, which is likely to result in patients losing out on quality and continuity of care as they’re shunted towards “healthcare professionals” in urgent care centres instead of seeing their own GP.3

Our integrated care board (ICB) has brought in a team of management consultants to help work out what should happen next. They recently co-hosted a lunchtime webinar to launch their programme of work, an event attended by around 150 GPs from the area. After a presentation outlining (very vaguely) their plans to find out what the current problems are (something most attendees already know) and a lot of warm words about stakeholder involvement, the floor was opened for questions.

The first questions were: “How much are you being paid for this work?” and “What budget did it come from?” The webinar didn’t get much further, as a lack of straight answers merely led to the same questions being repeated in different ways. We learnt that the money wasn’t coming from “patient facing” budgets, but this wasn’t what had been asked. Subsequent research has shown that the price tag for this six months’ consultancy work on the provision of primary care strategy is £300 000.4 No questions were asked about the actual work proposed, and the combined anger of the virtual room was palpable.

This kind of overt antipathy isn’t at all in keeping with the corduroy-and-cardigans image of GPs—clearly a stereotype well past its retirement age. Perhaps most doctors are aware of research from Warwick University about the lack of benefit derived by the health service from external consultants, or perhaps they’ve simply absorbed the idea that a management consultant is someone who borrows your watch to tell you the time.56

Given that this was a launch event with the stated aim of engaging with local GPs and encouraging us to work with the consultancy team, it’s difficult to imagine a worse start. I believe that the ICB is hoping to come up with a shared vision for the future of general practice in our area—or at least one that the people working in it are happy to sign up to. One major prerequisite for developing that vision is trust: specifically, GPs’ trust that the ICB, any consultancy they employ, and, ultimately, NHS England have our best interests and those of our patients at heart. On the evidence of this meeting it will take time, effort, and a lot more transparency to build that trust.

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