Published by Alexander Hitchcock on 7 April 2016
- Our Work
- The Reformer Blog
12 April 2016
Today, Reform publishes its latest research on general practice, Who cares? The future of general practice. The report concludes that to serve the needs of an ageing and more chronically unwell population, general practice must radically change. General practices should offer a wider range of services, seven days a week. Technology and a more diverse workforce are central to delivering this change.
These conclusions will be well-recognised by primary-care staff – 70 per cent of whom believe the current system requires fundamental change. The current model, built for 1948, operates on small scale, delivering care that is disconnected from the wider health service. Small scale, as the Care Quality Commission has shown, correlates with poorer care. Professor Steve Field, its Chief Inspector of General Practice, has drawn the link between scale, the ability to offer multi-professional teams and quality.
The future should be very different, however. A new workforce model can save the NHS money and free GPs to provide for those with the most complex needs. Experts interviewed for the research estimated that 50 per cent of appointments could be delivered by other clinicians. If nurses delivered the 15 per cent of appointments dealing with minor ailments, the NHS would save over £700 million a year. These changes would ease GPs’ workloads and enable them to offer longer appointments, up to 20 minutes, for those in greatest need. They would also allow the Government to scrap its target of employing 5,000 more GPs by 2020-21, which is a sticking plaster for an out-of-date model.
Larger scale allows providers to deliver extended services. Lakeside Healthcare, an NHS ‘vanguard’ super-practice based in Northamptonshire, provides an urgent care centre for 200,000 patients at one-third of the cost of an A&E. Taurus Healthcare in Herefordshire has shown that demand for seven-day opening hours rises steadily when introduced: the proportion of weekend appointments utilised rose from 40 per cent on offer to 80 per cent between January and December 2015.
Policymakers should act to harness the energy of GPs craving change. In so doing they must be fearless: commissioning bodies must be more integrated to deliver joined-up care, and the number of clinical commissioning groups should be reduced to hold larger providers to account. Contracts must also change. Current open-ended contracts stifle competition, which affects care. GP practices should compete regularly – every five to 15 years– with each other, private companies and international organisations for the right to treat patients.
Radical change of general practice is at the heart of the Five Year Forward View. This report outlines a blueprint for delivering higher-quality care at a lower cost to the NHS.
Find an interactive blog here.
Alexander Hitchcock, Researcher, Reform