Episode 54: Backstage with Amanda Doyle

And I'll come back to your leadership journey actually in a moment.

I know you don't like calling it a journey, but a series of accidental events that led to where you are today.

I do want to come back to that.

But now that we've started talking about contracts, actually, my curiosity can't be curtailed.

So I wanted to just ask you, I just think that is a really difficult job to do.

And I have a lot of empathy for you, Amanda, when I see you come on these NHS England webinars, having to defend, explain, justify some of the things that have come through the contract.

I want to give you an opportunity to the degree that you are able to just explain to people, what do you wish the average GP understood about what it's like for you having to do these negotiations or what are the things that they may not see that you wish they could see? And I know you can't be specific, but

I just think it must be tough and I'd love to hear your side of it.

So I think what's really important to understand is a lot of the things that practices and GPs find frustrating, sometimes people behave or speak as though it might be my idea that we don't give extra funding to general practice to do something and nothing could be further than the truth.

So if people think that I think everything should be fine and practice should be able to deliver everything we ask and that I think the capacity is there and they're just not organized well enough that they're deluded.

This is not the case.

Quite often, what is the best we can do in the circumstances in which we live? So we get at the start of each contract, negotiation or consultation period we are given a financial envelope within which we have to live and so quite often what we see is the best we can do within a financial envelope not everything we want to do and here's some additional money for it and so that's one thing the other thing is We have to remember that the point of the contract is not difficult as it is to get the best possible deal for GPs.

The point of the contract from NHS England and the Department of Health side is to get the best possible deal for patients within the context in which we're working and within the financial envelope which we've got.

And the BMA's job is absolutely to get the best possible deal for GPs.

And sometimes it's the back and forward around the consultation discussions are about that.

How can we get a sweet spot that meets both? But we also start off with a list of government asks.

And ministers have made commitments to the public about what they can expect to see.

And we have to find a way to deliver that through the contract.

And so with the best will in the world, things like a focus on access over the past couple of years, not all GPs recognize that as their number one priority, but actually the general public recognize it as their number one priority.

And almost all of the drop in patient satisfaction with general practice that we saw over the past three years was related to not the quality of care they get, not satisfaction with the service, but their ability to get in touch with their practice and arrange, either give the practice information or arrange appointments.

And so we've really focused on that.

Actually, outcomes, clinical outcomes are really important too, and we need to recognize that.

We had very long discussions over Quah, for example, and we went out to consultation and ended up with something which said, look, we want to reduce the amount of tick box practicing that we're asking of people, but we actually don't want to remove the focus on the big killers and the benefits that you actually look back from when QOF was introduced, the benefits to patients that came in almost immediately in the first year were staggering.

Even just admissions to hospital, the conditions related to some of the key QOF indicators, massively reduced in one year.

And so we need to not forget that.