Where I live, the front of the hospital has “1887” carved into its stone facade.
These pinnacles of clinical speciality will loom large in the civic landscape long after the next NHS reorganisation, as predictable as the annual flooding of the Nile.
Perhaps only the general practitioner can match the ‘cathedral on the hill’ for permanence. The local family doctor has been a recognisable part of our lives since Miss Polly had her dolly.
For more people more of the time, the ease or difficulty of seeing one’s doctor is a greater measure of satisfaction than the headline-grabbing 18-week target for treatment referrals.
The King’s Fund recently published Commissioning and Funding General Practice: Making the case for family care networks. It sets out a model for primary care that has larger networks or federations of GPs at the scale needed to provide the range of services integrationists are looking for.
These networks would have commissioned contracts funded on a capitation basis. Local commissioners may be allowed to let innovation flourish with different models in different parts of the country.
CCGs are currently thinking hard about co-commissioning primary care alongside NHS England. Each of us has placed ourselves on a three-point scale of readiness and willingness to become part of the new commissioning and regulating arrangements.
Simon Stevens has announced this new option as offering “a greater influence over the way NHS funding is being invested for local populations”. You will have already joined the dots and seen how a pooled budget with CCGs would allow a council involved in health and wellbeing to commission for many of their outcomes from primary care.
So far so good: a partner capable of dealing with complexity that is understood and trusted by residents.
However, the stark concerns raised about the sustainability of general practice are well known. There is a shortage of doctors in general and an even greater shortage of doctors wishing to invest their own savings in the small business that is an equity partnership.
Practices in difficult areas and in substandard accommodation are faring even worse.
If only there was a local body, with foresight and buildings, able to support and nurture salaried clinicians.
We may not want to limit the role of place-shaping local councils to joint commissioning with CCGs.
Perhaps they may choose to sustain general practices as they become part of a family care network that is grounded not just in the unique circumstance of the neighbourhood, but in our civic history.
Rich Hornby is chief finance officer at Coastal West Sussex CCG. Before that, he was finance director at West Sussex CC. He tweets as @Nyesdad