A new Nuffield Trust report finds initiatives that offer faster and easier access to GPs for some patients risk undermining the ability of doctors to manage people with complex or unknown illnesses and keep them out of hospital.
‘Divided we fall: getting the best out of general practice’ draws on a Nuffield Trust roundtable event, examples of services across the world and academic literature. It looks at the consequences of the recent trend to split general practice up into different types of services for different patient groups. These include services like walk in centres for people who prioritise quick and convenient appointments, and others which focus on frail older people or care home residents.
The report warns that with a serious shortage of GPs, these rapid access services pull doctors away from their traditional “medical generalist” role where they can provide continuity of care and focus on understanding patients in the social and family contexts that shape their health.
Displacing this ability to manage patients in the round could mean losing the value that GPs provide to the wider NHS by avoiding more intensive and costly forms of care. Easier access services themselves may deliver limited extra value. The report finds no clear evidence that they save money and some emerging evidence that they increase overall costs.
The report suggests ways in which GPs can combine the strengths of traditional general practice with the advantages of different services for different groups:
- With a shortage of GPs and rising part time working, continuity with one doctor can be hard to come by. One way to address this could be through 'team-based-continuity' with small groups of professionals who develop an ongoing relationship with patients.
- Software analysing patient data can be used to work out whether each person would benefit more from faster access, or continuity with a doctor or team who can manage ongoing conditions.
- Technology should be used more effectively in all local practices to support easier access, monitor long term conditions and more, so that patients feel less reason to go elsewhere.
It ends by calling on national policymakers to move away from splitting off services and to support better access, better continuity and medical generalist care within GP organisations.
Notes to editors
- ‘Divided we fall: getting the best out of general practice’ is written by Dr Rebecca Rosen and will be available on the Nuffield Trust website.
- The Nuffield Trust is an independent health charity. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.