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Dr David Geddes, NHS England’s Head of Primary Care Commissioning, gives his views on the Call To Action challenge facing GPs and how team work is the way forward:
Over recent weeks I have attended a number of events hosted by area teams to discuss with CCGs and key local stakeholders ‘Improving General Practice – A Call To Action.’
Across England, the story appears the same, general practice and wider primary care services are facing increasingly unsustainable pressures, and there is recognition that primary care wants and needs to transform the way it provides services to reflect these growing challenges.
The challenge for primary care and the wider NHS is how to enable primary care to play an even stronger role at the heart of a more integrated out-of-hospital services, delivering better health outcomes, more personalised care, and excellent patient experience, in a sustainable way and as efficiently as possible. The elephant in the room is that we need to deliver all this seven days a week.
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. At one event, the chief executive of a local hospital told how a consultant had to cancel his entire clinic, so that he could see his own GP.
If general practice is serious about offering health promotion and early intervention, then we need to be available to do this for people at a time that suits them. 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.
How can this be done when we are already facing a workforce crisis, when our own working day is too long and GP morale feels to be at an all-time low? How can capacity, that already feels so stretched, now be extended over 7 days? Whilst it is true that answers to these questions did not come thick and fast, there was some interesting debate about what could be achieved.
A recurring theme at the Call To Action events was that we don’t need more of the same! Many described how they already have upwards of 40-50 consultations a day, seeing ever more complex problems, but with no slack in the system to give a corresponding increase in appointment length.
I work one day a week in a small practice of 5,200 patients with three other part-time partners. Stand alone, we can’t offer a service 8am-8pm, seven days a week. But we could if linked with other practices using the same IT system, to create a practice network.
In the past, we have worked as a small GP cooperative, where a relationship existed between practices and we could ensure an effective ‘hand over’ of care for our most vulnerable, sick and dying patients. We told patients who they would see if they deteriorated, and we could share information with the attached community team.
That was more than 10 years ago. 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.
Where is the additional human and financial resource to deliver this care? There won’t be a single solution. The challenges facing rural communities are far different to those facing inner city general practices, and resource issues will differ.
However, I believe that this challenge offers us an opportunity to stop and reflect on our current way of practice. We should not see this as an additional 40 per cent of work, but 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 of care should be measured in terms of how care is delivered by a well-informed multi-disciplinary team. 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.
I believe there will be advantages for the profession. As presentations in surgery become ever more complex, is it appropriate still to offer a 10 minute appointment with the option of an occasional ‘double’? Do we get professional satisfaction trying to manage a patient with three or four long term co-morbidities within such restraints? Creating space for consultations across a seven day period could be an opportunity to offer patients a range of appointment times, using skill mix and spreading the workload differently.
For many GP colleagues, juggling a working career with a young family, working at weekends may provide much needed flexibility and an option some would actively choose to do. And am I alone in finding it increasingly hard to know my colleagues across the GP community? In the days of the GP cooperatives, there seemed to be far more coming together, opportunities for discussion about patient care, about general practice and about life.
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.