Having had the opportunity to observe English general practice and the broader NHS for the last few months the question I am left with is this – is English general practice and primary care currently equipped to deal with the challenge of moving forward?
Recently released data shows that over 50 per cent of GPs in the UK are providing more than 40 consults a day – demand is continuing to grow as the population ages and the pressure grows as more expectation is placed on general practice to deliver broader solutions for the struggling health system.
In talking to a wide range of GPs there is an agreement that general practice is essential to providing the co-ordination and continuum of care that patients need. There is a strong sense that developing this along the lines of the primary care medical home may be the logical solution to delivering better patient outcomes and assisting with managing the affordability of the broader system.
However general practice also appears to agree that it is ill equipped in its traditional organisational form to meet the current and future demand. One common belief is that additional funding is the sole answer; however it’s not clear what it will buy.
GPs need to construct something beyond the current operational norm to ensure that clinically safe, sustainable and patient-centric services are provided
The consensus within general practice around its weaknesses isn’t shifting to provide an effective response around how to redesign itself for the future.
On the front line GPs generally appear resigned to just working harder (or leaving for other options) and seem to be deeply cynical around broader health system views on general practice or national bodies’ attempts to articulate a future for them.
There are small pockets of innovation emerging within some larger practices, or small groups of practices, but often this is focused on the additional services that general practice can provide rather than redesigning the way core general practice is delivered.
Clinical commissioning groups (CCGs), conflicts of interest, section 75, political prodding, and ill-considered hot-flush responses to the 24/7 question swirl around, detracting from the real debate. How will general practice work in the coming years and what does general practice need to look like tomorrow?
Practices and GPs are immersed in day-to-day provision and lack the capacity to construct an effective response at a collective macro level. GPs need to construct something beyond the current operational norm to ensure that clinically safe, sustainable and patient-centric services are provided.
CCGs have a role to play but are burdened with whole-system development, commissioning and the demands of a high cost, transaction-focused system. The key role they can play is supporting and enabling general practice to develop different models through new contracting vehicles.
General practice needs organisational, system and economic development at a grass roots level.
Some of the more innovative GP partnerships have internationally and on a more limited local basis have this desperately needed big-picture view that is translated into a local vision for the future.
Blending clinical and management capacity close to the front line action, they are effectively supporting general practice to develop – but also creating a primary care presence in the broader system that can influence the construction of the whole system.
General practice is starting to drive the system collectively with hospitals rather than being “done-to” by the system.
Networks are thinking beyond the traditional defensive advocacy role employed by national groups. Contracting can transform from an adversarial model to collaborative and innovative models allowing creative solutions.
Existing GP networks are also starting to challenge themselves and their members to achieve better collective outcomes. That improved performance can add immense benefit to the whole system.
New models of care are also being designed and developed by networks at a practice level to enhance the patient experience and increase their ability to deliver to the increased demand safely.
Imagine a day with no more than 21 face to face consults, being able to spend 20 minutes with those patients who needed it, having protected time for phone calls and email - all with patients who felt they had better access to their GP and their broader primary care team than ever before, albeit not always via traditional face to face consultations.
The secret sauce of general practice needs to be protected – the one on one relationship between the patient and the GP, the personal touch– but just trying to do the same as ever faster than ever guarantees to spoil it. A rethink and reorganisation is needed to ensure that all those in retirement can access the care and style of service that we all value.
John Macaskill-Smith is Chief Executive at The Midlands Health Network, New Zealand. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.