General practice in need of modernisation and investment – RCGP report
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- Published: Wednesday, 03 December 2014 07:55
- Written by News Editor
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The Government should set up a ‘transformation fund’ to drive a seismic shift 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, commissioned by the Royal College of General Practitioners (RCGP).
The report calls for a revolution in the way general practice is delivered, moving 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.
It also calls for a new relationship between patients and clinicians. 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 to 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 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
- Merge back-office functions
- Ensure high quality out of hours care
- Offer a step-change in online access to clinical consultations and patient records.
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’. It adds: “In some cases, high levels of compliance have become a requirement of the regulator. In these circumstances, the GP is under considerable pressure to persuade a patient to accept a certain medicine or intervention.”
The report also calls for a change in attitudes among clinicians across the entirety of the NHS. It says: “The shift to delivering more proactive and patient-centred care within general practice is also in some instances being held back by traditional attitudes and behaviours in regard to care delivery. It will be vital to encourage and enable health professionals to provide holistic and personalised care, and to support patients to play an active role in managing their own health. This requires professionals to work with patients in a very different way, demanding new skills, knowledge and ways of thinking about the dynamics of power between professionals.”
The report can be found at:
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