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General practice needs ‘radical change’

Report calls for move away from traditional ‘cottage industry’ model

Mark Gould

Monday, 24 November 2014

The Government should set up a "transformation fund" to drive radical changes in general practice – to deliver better care for patients, enabling people to take more responsibility for their own health and utilise modern technology to access services remotely, according to a major new report.

The report, An inquiry into patient centred care in the 21st century, states that, practices working together at scale could become "multi-speciality community providers" which, as well as having GPs, would include specialists, pharmacists, social workers, community nurses and workers from the voluntary sector. This could enable them to offer patients a wider range of clinical and community services, raise standards of care and merge back-office functions to deliver efficiency and economies of scale.

Working as large scale community providers would also ensure high quality out-of-hours care and offer greater online access to clinical consultations and patient records.

The independent report, commissioned by the Royal College of General Practitioners (RCGP), says general practice must move away from the traditional "cottage industry" model of small, relatively isolated surgeries towards an era where clinicians work differently with patients, and practices increasingly work together at scale – for example in federations – with other parts of the health service.

The report also calls for a new relationship between patients and clinicians. It says this is needed to meet the diverging expectations of patients in the modern era, with many wishing to take advantage of rapid developments in IT to access clinicians and to take more responsibility for their own care, and a growing number needing increased support due to the explosion of those with multiple long-term conditions.

According to the report, the Government and NHS England urgently need to increase funding for general practice and wider community-based care, following a decade throughout which investment in hospitals has grown while funding for general practice has fallen substantially, with just 8.5% of the NHS budget now going into the family doctor service.

The report, written by former NHS Confederation Chief Executive Mike Farrar and a team of 10 advisers from across the health care sector makes 46 recommendations, including calls for:

  • A move away from tick box clinical guidelines and performance indicators to an approach that recognises the need for care to be tailored to patients with complex conditions and rewards clinicians for respecting patients’ preferences, instead of penalising them both financially and reputationally.
  • Implementation of NHS England’s ‘new deal for general practice’, building on its key strengths including an easily accessible, local point of access; comprehensive services from a generalist clinician; continuity of care; and the registered patient list.
  • More resources and support for patient participation groups to help shape services and promote a culture change across primary care in which patients are equal partners with doctors, and
  • Action to ensure a substantial and sustained increase in GP training numbers, including incentives to attract trainees into under-doctored areas.

The report says that the current target culture in the NHS leads to patients sometimes getting the wrong type of care. It says: "Some patients are pushed into [treatments] that they do not want, while they are denied other forms of support they need".

The report argues this situation is caused by the "many guidelines in use in general practice that encourage GPs to recommend a particular intervention or medicine to patients with a specific condition".

Inquiry chair Mike Farrar said: “Given the pressures created by the age of austerity and the explosion in the number of people with more than one long-term condition, it is imperative that the Government sets up a ‘transformation fund’ to drive forward a revolution in general practice and wider community care.

“With an ageing population, changing public expectations and resources becoming increasingly scare it would be indefensible to continue delivering healthcare through models of care that were designed for the needs of a by-gone era.

“It is becoming increasingly clear that we need a seismic shift in the way care is delivered, as well in the attitudes of clinicians, to ensure we can provide care to patients that is centred on the individual and as close to home as possible.”

RCGP Chair Maureen Baker said: “GPs across the country will embrace the call to adopt new ways of working in order to ensure better patient care, but – as this report highlights – this can only be delivered with far greater levels of investment in community care, and we call on the Government to act on this as a matter of urgency.”

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