General practice and community care in need of radical modernisation and more investment – according to major new report, UK
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.
The independent report, commissioned by the Royal College of General Practitioners (RCGP), 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.
The report – An inquiry into patient centred care in the 21st century – 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 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.
The Royal College of General Practitioner