The evolution of general practice: broader networks, multi-disciplinary teams

Case study summary

Since the birth of the NHS, the role of the GP has gone through much change – but it remains an invaluable part of modern medicine.  A group of GP leaders discuss.

 

While the importance of the GP to the health of local communities remains undiminished, general practice is feeling the pressure of demand, with a population that is living longer with increasingly complex conditions. A group of GP leaders explain that, while the role of the GP is changing, it still remains at the forefront of modern medicine.

With the vast majority of NHS patient contact being in general practice, demand for GPs is not only increasing but also diversifying. “As a GP, I’m dealing with complex multi-system disease, uncertainty and juggling the many different problems the patient has, including mental health issues,” says Dr Simon Gregory, who leads on general practice and primary care at Health Education England, and is also a GP himself.

As the role is growing and developing, Professor Maureen Baker, immediate past chair of the Royal College of General Practitioners, points out that the first priority has to be ensuring there are enough GPs to meet demand. More medical students need to join the profession and more existing GPs need to stay. Baker notes that the combination of an ageing population and a recent baby boom has also resulted in an increase in demand. “Both extremes of the population are high users of general practice services,” she says.

Increasing the number of GPs and attracting more young doctors into general practice is at the heart of work that Health Education England is carrying out with NHS England, the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA). “Bright young aspiring doctors need to see GP as a positive career choice,” says Gregory.

Retention is also a key priority, and work will seek to encourage those who have left the career to return or those who are thinking about leaving to stay.

GPs see such a broad range of patients that they are in a unique position to play a greater role in academic research, says Gregory. Dr Krishna Kasaraneni, chair of the BMA’s education, training and workforce general practitioners committee, agrees, arguing that more needs to be done to attract people into the profession. He has seen colleagues leave the NHS to work abroad, and believes that to retain GPs, they need to be offered “innovative ways of being part of the clinical workforce”.

Collecting high quality data about patients’ experiences and conditions will be integral in shaping the future of primary care and medicine overall – another way research will play an important role. As the RCGP notes in its report A Vision for General Practice in the future NHS, by 2022, GPs will need to show that their practices “systematically monitor quality and promote learning as part of their everyday activity”.

Fundamentally, general practice has changed significantly since the formation of the NHS. The vision for the NHS, shared by many, is a primary care provider that offers more services centred around a multi-disciplinary team. This team would include highly skilled nurses, paramedics and other roles, able to provide personalised care to patients. NHS England has already committed to an extra 1,500 clinical pharmacists in general practice by 2020/21.

Clinical pharmacists are experts in disease and medicine and can help improve services for patients such as managing often complex medication needs.

Dr Arvind Madan, A GP in south-east London and NHS England’s director of primary care, says: “General practice has changed over the years. Even if we hadn’t seen unprecedented demand, the case for change is undisputed. No longer should or can we have GPs working in isolation. We are starting to see the development of a network of staff, as we have in our hospitals, working closely together to provide the best and most timely care for patients. In the future, I see the GP drawing even further on their leadership and in-depth clinical skills to manage and facilitate care to the public across the wider team. ” Teams are already coming together alongside broader networks and federations of GP practices, Madan adds. The GP role is being supported by the increase of roles such as clinical pharmacists and physician associates.

The future of general practice is one where patients will be able to choose from a range of specialists depending on their requirements. For example, patients with multiple chronic conditions could have their medications reviewed by pharmacists who can advise on how they interact with each other. Much of the burden of clinical paperwork will be taken on by trained clerical staff, freeing up more of GPs’ time so they can focus on complex patient care.

Gregory firmly believes that general practice will remain one of the most intellectually stimulating in medicine. “General practice is the branch of medicine where people will be able to continue to use the full breadth of their skills and knowledge every day. It can be described like a lifelong sudoku – it’s a different challenge every time. That’s why I still love being a GP – and we need to get that message out to help attract more people into the profession.”