• Rant Control 04 February 2019 | View comments

  • 4th February 2019 | By David Jolley

    Through the week we have exchanged thoughts about the learning from Gnosall’s successful memory service in Primary Care. That service, successful and sustained after more than 12 years, has generated international interest and added to enthusiasm for care of people with dementia and their families within Primary Care. Unhappily three attempts to extend the principle to other Primary Care services in Staffordshire and Shropshire have foundered.

    During this month we have been told that greater use of electronic technology for and by patients will make for much better use of resources and knowledge https://www.england.nhs.uk/2019/01/long-term-plan/ . This is something which one of our discussants has supported strongly. The problem is, I might venture, that much of healthcare need is amongst older people, some with dementia, and many of them are not computer-savvy.

    The Gnosall models brings clinical expertise directly to patients and families and that expertise remains available in the Practice throughout the life of individuals with dementia. The experience of the roll outs has been that everyone has liked the principle but that organisations have been unable or unwilling to accommodate them within gigantic, rule-ridden protocols which do not want to know about continuity of clinical responsibility or clinical freedom.

     ‘Large organisations cannot allow autonomy as it may affect the integrity both of the organisation as a whole but also the individual divisions.’

    And in that we have the essence of the problem: the health and wealth of the large organisations such as NHS Trusts or private sector providers has been allowed to become the first priority. What is best for patients, families and the health and wealth of the nation as a whole has been set aside.

    So we have an understanding. So we rant. Can we please regain control!

    Better use of technology may have advantages for some, but old-fashioned, person-centred good practice has so much more to offer.

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