Mword Issue 92 – Dr Michelle Drage’s latest update for GPs and practice teams

  • Mword

28 October 2021

Dear Colleague,

The Parable of the Horses on the Cliff

While practices are digesting the BMA GPC England Resolution in response to the onslaught we have been experiencing, and the imposition of the NHS England so-called ‘Support Package’, we are now waiting for CCGs who today are required to submit to NHSE&I their lists of “the 20% of practices locally with the lowest level of face-to-face GP appointments – as opposed to whole practice, including appointments with other staff”, who are being deemed to demonstrate “unacceptable variation”. See clause 42, page 14 of the document.

Rest assured if your practice does get listed as being in this arbitrary ‘bottom 20%’ we will be there to support you.

Meanwhile, I hope that the following, written by my good friend and colleague Dr Fay Wilson, one of my former Londonwide LMCs’ Medical Directors and longstanding member of the GPC, explains the sentiments of where we are. Please read and appreciate:

We are in a coach where we used to be the drivers, the people along with us used to help and support, fix things, provide supplies and generally keep our show on the road. They were pleased with what we did and supported without getting in the way.

Gradually over time we realised they have taken over the steering and control of the coach. They are taking us in a direction we don’t want to go, faster than we think is safe. They don’t listen but press on. They tell us we don’t work hard enough, that the horses can go faster, that they don’t all run at the same speed or for the same distance and some of them eat too much.

They don’t listen to our explanations or proposals to enable slower horses to run faster and the coach to get to its destination more easily and economically, and we cannot persuade them to listen. We stop talking to them in the hope they will realise they don’t know the way without us and need our help. However, although they slow down a little they try to prove they don’t need us by taking other advice. We say ok and after a discussion between ourselves we start talking to them again.

They carry on listening to the people whose advice they prefer. In response to us going back to talk to them they set out to teach us a lesson and prove they are justified in ignoring us. They start to whip the horses to make them go faster, beating them harder if they think they are among the slowest fifth of horses, even if they have not been fed and have a heavier load (especially with all the people on board).

We see we are heading towards a cliff, they are going to steer us over it and we will be dashed to smithereens on the rocks below. Their siren voiced advisers have told them they will safely jump off the coach, dust themselves down and having disposed of us, invite the spectators to run the new coach service.

We should not be looking for a win or to prove we were cleverer or know better than them, or to see them bite the dust. We might just manage to shock them into paying attention for long enough to realise if they steer us over the cliff they will fall over too, lose their horses and probably their coach; and realise before it is too late that those advising them don’t actually know how to drive coaches, they just think it must be easy and cheap because they have seen us do it.

All I want them to do is to stop whipping the horses, slow down and consider that the coach and horses are safer and more productive if driven by careful and experienced drivers and they should sit down and talk to us about it.

I do not want to meet my end flying over a cliff. I do not want the horses to suffer that fate. We are shouting in the ear of NHS England and their leader Mr Javid just for long enough to make them stop what they are doing and think.

For us to make an impact we all need to shout in their ear. They will not listen to me on my own and if I can’t distract them and we together can’t capture their attention we will all be over the cliff.

I am confident that we can do it.

Let’s stop fretting about where we are going and the different routes we could take. Let’s just agree not to go over the cliff. Right now, I would be content to be anywhere other than over the cliff where NHS England are steering us. I object to cruelty to horses and I am not ready to fall to my doom.

And so ends the tale.

Please do share the MWord among all your practice colleagues. As ever, I welcome your feedback at The team of experts and leaders here at Londonwide LMCs are by your side.

Keep well. Stay safe.

With best wishes





Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs