Who cares? The future of general practice

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allow the Government to scrap its target of employing 5,000 more GPs by 2020-21, which is a sticking plaster for an out-of-date model.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

Comments

Comments

Michael Wray, senior software architect at Inhealthcare

18 April, 2016

While the bundles of paper records dragged along hospital wards each day blatantly demonstrate the technology problems that exist in secondary care, the same charge cannot be levied at primary care. GP systems operate slickly for all those things primary care practices do every day. They enable rapid appointment booking, prescribing and they allow a GP to get through his or her mountain of 50 patients a day. Some might describe them as glorified CRM systems, but they are built that way for a reason. The technology is purely an enabler for the business model of primary care, and the business model is driven by the way services are commissioned. As services start to be commissioned in more sensible ways (around the patient rather than around conditions), we should start to see new models of care delivery. These will involve diverse teams which will only be able to succeed if they can work in a coordinated way. This means process, workflow, compliance and audit; it means the management and orchestration of the teams so people know what they are doing and are able to measure how well they are doing it. These will only work if the patient is at the centre, and therefore has a significant role in the team. Technology must be the enabler for these new models, delivering appropriate communication and information flows. The statistics in the report perhaps suggest patients don;t use online services, but this is down to the fact that the GP online services don't offer anything new. Why would a patient go to the trouble of booting up their computer and logging on to book an appointment when they could just pick up the telephone? It's only those who've worked out they can jump the queues by logging on at 8:30am who ever use it. This is not using technology as an enabler; it is not digital health. Digital health is about enabling new care models, using technologies that help with process, workflow, compliance and audit, using the communication channels most appropriate, be it online, mobile apps, SMS, phone or connected device. It will help include the patient in their own care, it will automate the mundane and it will allow us to measure the effectiveness it terms of health outcomes and delivery cost. Only then can we tackle the long terms conditions, not only in patients, but in primary care too.

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Greg Wood

12 April, 2016

You're right about an ageing population. That, immigration and changing patient expectations will be the drivers of change in the future, I reckon, rather than government/NHS policy. The other side of the coin is the changing face of the healthcare professions, especially doctors - many of whom work part-time and some of whom are now actually on strike!!