Founder of GP Access Ltd, with the vision "to transform access to medical care."
Helping general practice change to increase capacity and improve access and continuity for patients. We do this through the askmyGP online service and GP telephone led interventions.
An engineer by background, I'm interested in what works, why and how it can work better.
Huge efforts getting data on a stupid non-contractual measure, extended hours. When the simple useful measure, average time in days waiting to see the GP, which is what actually matters, gets no mention.
Analysis I've seen shows that GP appts in non-practice hubs cost approx 3 times those in core general practice where the patient is registered. It's a function of longer duration, lower utilisation and high rework (refer back to own GP). This is such a disastrously expensive alternative to what works that I'm astonished to see NHS England proposing it and BMA saying anything whatsoever in support. Get the resources to where they work best, in core GP!
What NHS England doesn't or doesn't choose to realise is that opening hours are not the issue for access. The same GP time spread more thinly over the day, evening and weekend is the same GP capacity. Good access is so much easier than this. We keep telling them.
Exactly how do we know that appointments given in hours for a private fee are not in time taken away from NHS patients? Seems to me this cannot be audited, therefore it will be abused.
Why do you think he knows what needs to be done? The GPFV and contracting proposals are skewed toward "scale" for which the evidence is lacking. What's needed in GP is method to tackle demand and increase continuity, not jiggle around with structure.
Patient survey data is of little practical use as it hides a great variation in performance, and doesn't even hint at what to do to change said measures. So a few of the practices in there will be ones we have helped, where it becomes the norm to be in contact with your own GP (yes, even a choice of GP) within minutes, not days, and it costs the same. To all the knee jerk Pulse comment crowd, just saying.
Strange, then, that I was with a practice in Belfast who had a 10 day wait, and reduced it to an average now of 22 minutes. Read that again. I mean 22 minutes. Doing things differently. And the GP Dr Andrew Courtney said to me, "My stress level has dropped from 100 to zero"
It's muted, but it is a rare sign of a politician if not bowing at least nodding to the evidence. He is still missing the real problem, which is the 100,000 plus patients turned away by GP receptionists in hours. Extended and weekend hours worsen this problem.
Well said. Investment in general practice will have the greatest leverage on health care benefit and health care spend overall in Scotland.
Has Simon Stevens been reading William Osler? " “The cultivated general practitioner: may this be the destiny for a large majority of you. You cannot reach any better position in a community." Well said. This is a huge boost for GP and I'm with Martin, but Stephanie raises an important point on smaller surgeries. Their should be no discrimination, and I'm afraid the headlong rush for scale is without an evidence base. I've just discovered the best ever performing practice in 5 years of work, and it's a single hander with 2,700 patients.
He also exhibits some strange obsessions. "Online" appears 22 times, and "scale" 15 times in the document. Writing for GPs, one might expect a little more on "continuity", which he really should understand. Only 4 mentions.
Like I said yesterday, the bombardment of doom was silenced - for a day.
7 day services have been a disastrous waste of money, and evaluated as such. Why is anyone allowed to pour another penny down this drain? The money is needed in core GP, where it is around 3 times more effective.
"at best delays the collapse" Only a GP could thus welcome a 14% increase in funding. Funding is always welcome but what's really needed is a change in thinking. This isn't it, it's tinkering and tweaking the existing state, with a few extra ideas thrown in. But perhaps it will enable something more fundamental.
Pure genius. And we know that all these Sunday hubs are the same. I even wrote a piece about it called "Hubtastic" which is still at number 5 on Google. Pouring taxpayers' money down the 7 day opening drain.
Good to see some new material on demand. Not unexpected result, and sensible numbers at 3.80 per year (RCGP/BMA have been saying 6, misleading by including other clinicians in one number for GP). Challenge is how to deal with this level of demand, not by wishful thinking that it will go away, or that we'll recruit 5,000 more GPs, but doing things differently. Oh I nearly forgot, that's what we do, DOI.
I'm with Martin and he knows the literature on the safety and quality of continuity far better than me. Specifically what makes the difference is relational not only information continuity. It's also labour saving as Martin points out, but further, there is not a trade off between access and continuity in a well organised demand led system. We've shown this in dozens of practices of all sizes.
So well intentioned, so poorly executed. Of course we want patients to have better access, but the PES has a incredibly feeble link to how access actually works for patients. You can drop the wait from 5 days to 0, the measure will hardly move. But reality for patients has changed. We need operational measures, and not silly incentives.
Er, well, we are already collecting very detailed information from patients, in their own time, and GPs are using it to inform the consultation and diagnosis. A fun blog by the way.
There is a vast gulf between surveys of what people say they would do, and what they actually do do. Interesting to see that more people visit NHS Choices Health A-Z every day than visit their GP - but they still visit the GP in the same numbers. A nonsense survey IMO.