Radical transformation of GP services to boost quality and access to care for patients across London “Doing nothing is not an option” – Dr Anne Rainsberry

NHS leaders in London have announced the first step in a radical transformation of GP services in London.

General Practice – A Call to Action, which is published today (Thursday 28 November 2013), was produced in partnership with some of London’s leading doctors. The aspiration is to transform GP services so they are more convenient, coordinated and holistic in order to address some of the frustrations of Londoners of not being able to see a doctor at a convenient time, or receiving disjointed care for on-going conditions.

London has world-class examples of general practice services. But general practice that served us well in the past is now under unprecedented pressure and is struggling to cope. In some areas, this is resulting in poor quality, inconsistent and variable care which is putting pressure on GPs, their teams and other NHS services. There is a growing consensus among health professionals that doing nothing is not an option and that an ambitious, city-wide approach is needed to address the needs of a growing and rapidly changing London, whilst retaining the best of general practice which has been the cornerstone of the NHS since its inception.

The challenges faced by London’s GPs include:

  • A booming population – London is expected to grow by 1 million people by 2020, or 13% by 2031
  • As our life expectancy improves, doctors are responding to increasingly complex health needs  –  with the number of over 65 year olds in London set to increase by 19% by 2020
  • A high number of short term residents in the capital, making it difficult for these patients to register with a local doctor
  • Stark health inequalities across London – with residents in different parts of the capital experiencing varying life expectancy rates and different health outcomes
  • Lower patient satisfaction with GP services than the rest of the country – with many Londoners struggling to see a GP at a time that is convenient for them
  • High numbers of smaller practices that struggle to offer the same access and range of services as larger or federated practices
  • A shortage of practice nurses, GPs and a high number of GPs nearing retirement age.

NHS England wants to begin the most wide-ranging conversation with Londoners and GPs about the future of general practice in the capital and how to transform care so it is fit for the 21st Century and the rapidly changing dynamics of London.  It will consider how better connectivity between practices could enable GPs to offer a wider range of services in a financially efficient way.

Dr Anne Rainsberry, Regional Director for NHS England (London), said:

“GPs play a vital role in our lives – from being the first port of call for expectant mothers to providing a lifeline to many elderly patients.

“But 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.

“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.

“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, former Chair of the RCGP and the newly appointed Clinical Chair of Primary Care Transformation in London, said:

“General practice is a 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.

“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.

“I look forward to working with my fellow GPs and patients on how we can build a world-class service that will sustain us for the next 50 years.”

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.

“This marks an important and positive step towards building services that are fit for London today.”

In the New Year, NHS England will 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. The service offer will focus on three aspects of care: accessible care, proactive care and coordinated care. GPs will then work towards these standards over the next 5 years, leading to a benchmark for the quality of care and services Londoners should expect from their GP services.

This transformation programme will also help support GPs to meet the new GP contract, which is a positive and immediate shift in the way GPs operate to improve services.