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London GPs facing ‘unprecedented’ pressures

Radical transformation needed if services are to meet capital’s needs and ease pressure on other parts of NHS, says NHS England

Caroline White

Friday, 29 November 2013

GP services in London need a radical transformation, if they are to cope with the “unprecedented” pressures they now face and boost the quality of care they provide, NHS leaders have said.

An ambitious, city-wide approach is needed to address the needs of a growing and rapidly changing population, says a report produced by NHS England in partnership with some of London’s leading doctors.

GP services need to be overhauled to even out variations and inconsistencies in the quality of care, which is putting added pressure on GPs and other NHS services, and to ensure services are more convenient, coordinated, and responsive to patients’ needs, says the report.

It outlines the challenges faced by the capital’s GPs, including a booming population that is expected to grow by a further million by 2020, with the proportion of over 65s increasing by 19% over this period.

There are a high number of short-term residents in the capital, who find it difficult to register with a local doctor, and there are stark health inequalities across London, the report points out.

Londoners are the least satisfied with GP services than people in the rest of the country, with many Londoners struggling to see a GP at a time that is convenient for them, it says.

There are many small practices in the capital that struggle to offer the same access and range of services as larger or federated practices. Better connectivity between practices could enable GPs to offer a wider range of services in a financially efficient way, it suggests.

Services are also suffering as a result of a shortage of practice nurses and GPs, made worse by a relatively high number of GPs nearing retirement age.

Dr Anne Rainsberry, Regional Director for NHS England (London), said: “London’s GPs say they are struggling against unprecedented challenges. A population boom, more complex long-term conditions and longer life expectancy together with rising costs means that many doctors simply can’t meet the demands placed on them.

That can often mean a long wait for an appointment, lack of choice over the doctor you see, and opening hours that don’t work for working people. It also means less coordinated care for patients with long-term conditions which can result in fragmented care,” she said.

“We’ve listened to London’s GPs and London’s patients and the verdict is unanimous: doing nothing is not an option. We must retain the great things about general practice that served us so well in the past, but we must also look at how we can care for patients over the next 50 years,” she added.

And she emphasised: “This is not about creating a ‘one size fits all’ approach to general practice. It is up to patients and GPs to determine how they will meet the changing needs of London communities.”

Dr Clare Gerada, immediate past chair of the Royal College of General Practitioners and the newly appointed Clinical Chair of Primary Care Transformation in London, said that general practice was bearing the brunt of the pressure to meet increasing and changing patient needs in London.

“We have a growing population in the capital. People are living longer and are developing more complex, chronic and long-term health needs. From a GP’s point of view, we are seeing more patients than ever before. This means up to 60 patient contacts a day, which previously would have only been seen in exceptional circumstances – such a flu pandemic.”

She added: “It’s clear that we need to change the way we work. Transformation needs to be radical and long-term – tweaking around the edges won’t cut it this time. We need to build strong networks between practices so we can offer more convenient and holistic care, when finances are tighter than ever.”

Dr Howard Freeman, Chair, London Clinical Commissioning Council, said: “There are ambitious plans to reconfigure NHS services in all areas of London. However all these plans are dependent on increasing capacity in primary care. If we do not improve access to GP appointments and provide more services in the community then London’s hospitals will become unsustainable.”

In the New Year, NHS England plans to work with clinicians and patients to create a set of proposals describing the service offer that all practices would like to provide and that all Londoners should have access to.

This will focus on three aspects of care: accessible care, proactive care and coordinated care. GPs will then work towards these standards over the next five years, leading to a benchmark for the quality of care and services Londoners should expect from their GP services.

Transforming primary care in London:  A call to action

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