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Primary care lead says GPs could embrace 7-day care

Current primary care model no longer fit for modern NHS, says David Geddes

Louise Prime

Thursday, 24 October 2013

The current model of primary care is no longer fit for a modern NHS, claims the head of primary care commissioning at NHS England. Dr David Geddes is urging GPs to embrace the opportunities presented by seven-day services.

He argues that while general practice and wider primary care services are facing unsustainable pressures, these could be alleviated by putting primary care even more strongly at the heart of a network of better-integrated out-of-hospital services – resulting in “better health outcomes, more personalised care, and excellent patient experience”.

Dr Geddes, a GP partner in a small practice in York, said: “Arguably, the current model of primary care is no longer fit for a modern NHS. We know increasing numbers of patients are presenting in general practice with multiple long-term conditions, working days are longer and retirement is getting later. For many of the population, (myself included) they never see their surgery open …

“If general practice is serious about offering health promotion and early intervention, then we … have to be able to provide a service that fits with the modern lifestyle, providing accessible services to those of us already leading busy and hectic lives.”

Dr Geddes questions the suitability for managing increasingly complex problems of the current appointment system, with its 10-minute slots and “the option of an occasional double”, and says that being able to offer appointments over a seven-day period “could be an opportunity to offer patients a range of appointment times, using skill mix and spreading the workload differently”.

He clarifies that he doesn’t mean “more of the same”, i.e. even longer working hours for GPs who are already at crisis point, seeing ever more complex problems in up to 40-50 consultations a day. He writes: “Stand alone, we can’t offer a service 8am-8pm, seven days a week. But we could if we linked with other practices using the same IT system, to create a practice network ... Now, with the highly systematic use of IT in primary care; we should be in a better position to provide coordination of care across the seven-day week.”

Finding the additional financial and human resource to deliver this care, he points out, will need very different solutions for practices in rural and inner-city areas. He says: “I believe that this challenge offers us an opportunity to stop and reflect on our current way of practice … a chance to re-distribute our working week, and to ask how we can do things differently and more effectively as a consequence.

“We should create opportunities to meet with community health and social care colleagues to develop the team approach ... Continuity is a team working in a coordinated manner to support patients with long-term conditions and complex health needs, not the availability of a particular doctor.”

Dr Geddes believes that the option of working at weekends could be welcome to many GPs, such as those with young families, and that working cooperatively could also bring about more “opportunities for discussion about patient care, about general practice and about life”.

He concludes: “Working across seven days will give many practices opportunities to work together in a different way, I believe this will reduce silo working professional isolation, and increase opportunities to collaborate in new and different ways which means that general practice truly will be able to play an even stronger role at the heart of a more integrated out-of-hospital service.”

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