John Copps argues that if new approaches to General Practice are to be successful, they must work for both patients and the workforce
“If General Practice fails, the NHS fails.” That is the stark warning from the NHS’s Five Year Forward View.
It is difficult to understate the importance of General Practice to the NHS: GPs are the gatekeeper of the system’s resources and the direct link between clinical care and patients in the community.
But, as anyone who works in the NHS knows, GP services are under severe strain. Demand continues to rise, surgeries are busier than ever, and GPs themselves report mounting workloads. Official statistics from earlier in 2018 indicate a 2.2% decline in General Practitioners and point to a crisis in the workforce. A reported 5.4 million people are unable to book an appointment with a GP outside of working hours. The knock-on impact is being felt across the NHS, including already-busy A&E departments.
The challenge for General Practice
This situation is unsustainable. A different approach to General Practice is urgently needed, and it needs to be more than extending opening hours. Any new approach, however, must heed three important structural and workforce challenges.
First, for too long, primary care has been a synonym for General Practice. As a result, there is a bottleneck. We need services that are not so reliant on GPs and involve other clinical professions, such as nurses and pharmacists. This is something that has been much talked about but rarely delivered on.
Second, the demands of being a GP have changed. In the past, where it might sometimes have been a lifestyle job that would fit around raising a family, GPs are working longer hours. Many find themselves balancing traditional clinical work with the administrative demands of being a partner in their surgery. Evidence suggests that this is turning off potential recruits.
Third, GPs expectations have shifted. Newly qualified doctors want the opportunity to work on a portfolio of different projects, including more complex clinical work in areas they care about.
Given these challenges, it is clear General Practice needs to provide a more attractive working environment for doctors. So, what new approaches can both deliver high quality patient care and help recruit and retain GPs? And how do we retain the strengths of the traditional model in terms of local knowledge and relationships which is highly valued by patients?
Collaboration, integration and digital
GP federations have provided a model of change over the last decade, built on the case for achieving economies of scale by sharing back office functions and standardising systems across groups of surgeries. Collaboration also involve expertise across the wider health system. For example, in Essex, GPs work with prescribing pharmacists and divide patient work between them. As part of Cornwall’s Living Well programme, Age UK places volunteers in surgeries to provide practical and emotional support for older patients, and manage anxiety around their health. These diverse models have been effective at managing demand and allowing GPs to focus their time on more complex clinical cases.
Another approach is integration of General Practice with upstream NHS services. In the Black Country, GPs surgeries have become part of The Royal Wolverhampton NHS Trust, bringing primary care, community care and acute care under one roof – in a variation of the Five Year Forward View’s Primary and Acute Care System (PACS) model. This gives GPs the opportunity to form closer links with hospital colleagues and become involved in additional clinical work, as well as reducing administrative demands on their time. According to data released earlier this year, the outcomes are promising too: emergency admissions from the integrated practices have reduced by nine per cent.
Elsewhere, digital technology offers glimpse of the future for General Practice. Babylon Health’s much-publicised GP at Hand app, being trialled in London, gives patients access to GPs wherever they are, through consultations by voice or video call. This is then followed up with a referral to a surgery if needed.
The publicity around GP at Hand has focused on uptake among younger, fitter patients and the deleterious financial impact of this on the traditional surgery-based model. This is an important issue but is more a consequence of the way General Practice is funded rather than the technology per se. GP at Hand still needs to be evaluated but, if the outcomes justify investment, there should be a way to accommodate both an app-based model and a surgery-based model. Anecdotal evidence suggests it is both popular with patients and it could give GPs greater flexibility around how and where they deliver care.
What next?
The growing demands of patients and pressures on GPs mean that the writing is on the wall for the traditional model of General Practice. The future lies in new models of collaboration, integration and the enabling power of digital technology.
NHS England’s ten year plan, due to be published in November, provides an opportunity to transform General Practice as part of a wider system of primary care. For new models to succeed, however, they must be attune to the needs and expectations of the workforce. If General Practice is to continue to be at the heart of a patient-focused NHS, it must work for both patients and GPs.
To learn more about our work in new model in healthcare and how we could help you, contact John Copps.