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- The Reformer Blog
1 December 2015
On Friday, the National Audit Office (NAO) launched a report on access to general practice in England. The paucity of data in general practice is widely recognised. Aymas Morse, Comptroller and Auditor General of the NAO, highlighted the impact this has, arguing that “[b]etter data is needed so that decisions about how to use limited resources to best effect are well-informed”.
Despite this, the report does point to important data regarding attitudes to the primary care workforce. In September, the NAO found that, in the event of a GP being unavailable, 65 per cent of people felt it would be acceptable to see a nurse.
This is an interesting finding given that the GP Patient Survey reports that 83 per cent of people contacting a GP practice want to see a named GP.
This preference is not surprising, patients are used to a system that has been in place since before the creation of the NHS. With only 1 per cent of the population using technology to access healthcare, few patients have experienced a different model.
For the small group who have used technology to access general practice the picture is different. Research by askmyGP, an online triage system, found that 75 per cent of 9000 submissions to a North London practice between March and October 2015 resulted in patients asking to see “anyone”— as the below chart shows.
Innovators are demonstrating, then, that patients are not opposed to primary care being organised differently – not least because they benefit from better access. The potential savings if policymakers recognise the opportunity are great.
An NHS Alliance report published in October found that 27 per cent of GP appointments in England could be avoided; and one in six of all appointments could be dealt with by another primary care worker. The Chartered Society of Physiotherapists has gone further, arguing that 30 per cent of GP appointments could be sent straight to a physio, and that if this happened for just a fifth of those cases, the NHS would save “at least” £525 million a year.
Crucially, an increased use of other clinicians would not result in substandard care. On the contrary, a review by the British Medical Journal demonstrated that nurse practitioners can offer the same quality of care and achieve higher patient satisfaction.
The NHS workforce has the potential to deliver efficient and excellent care. Front-line innovators have shown that people are receptive to change. Policymakers must now understand how clinicians other than GPs can deliver improved outcomes for patients, at a lower cost. Collecting better data, as Morse suggests, would be a good place to start. This would not only help to achieve the best for patients, but might also go some way to achieving the “true learning culture” that Jeremy Hunt desires.
Thomas Sasse, Research Assistant, Reform