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Independents' Day

Experts call for more evidence to back up move to new GP care models

Researchers have called for more evidence to be gathered about the clinical and financial impacts of new large-scale general practice models being pursued by NHS England.

A systematic review of data, published in the BJGP, concluded that 'good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce', with concerns raised about the future of care continuity.

The paper, authored by primary care researchers at the London School of Hygiene and Tropical Medicine, argued that 'as more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why'.

The researchers found that 'quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management'.

However they warned that 'unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care'.

The Nuffield Trust also voiced concern about the potential loss of care continuity stemming from an ongoing 'segmentation' of general practice, including the move to larger practices and extended-access hubs.

In a report published earlier this month, the health think-tank said that the 'rapid growth' of policies favouring quick, transactional, 'see and treat' GP encounters 'is pulling GPs away from the expert "medical generalist" role of general practice that is a defining characteristic of list-based primary care'.

The Nuffield Trust suggested that individual GP practices should 'develop systems to spot complex patients for whom continuity of care may improve outcomes and encourage them to stick with a single doctor or clinical team'.

Meanwhile, large-scale practices should 'monitor patterns of use of extended-access services to identify patients who could benefit from continuity and steer them towards their usual GP or GP practice'.

It suggested CCGs should 'commission access hubs that are fully integrated with patients’ usual GP clinics' as 'most are currently linked through shared access to medical records and few deliver extended access that can offer continuity with a patient’s usual clinician'.

It added that NHS England should 'invest in a research programme to identify which patient groups and clinical conditions can effectively be treated in transactional, rapid access services and which achieve better outcomes with greater continuity', whilst also looking at the costs associated with the new care models.

The report said: 'At a time when staff and money are in short supply, it is essential to clarify what we want from general practice and the role we want it to play in the wider NHS.

'There are opportunity costs associated with the current emphasis on timely and convenient access because fewer resources are left to deliver medical generalist and multi-disciplinary care.'

It comes as a recent study also questioned policies, having found that patients who are less satisfied with their GP opening hours are no more likely to attend A&E departments.

Readers' comments (2)

  • The drive towards super partnerships and primary care at scale is as a result of the lack of investment in the backbone of the NHS. The lack of recognition of General Practice as a specialty in its own right is part of the issue. The public has yet to be formally asked if the direction of travel is the one they want. In my experience there are two types of patients, those that just want a quick fix and don't care who or where they are seen so long as it is timely and convenient. The second type is the patient who cherishes the continuity of care and the relationship they have with their GP. The two types are interchangeable depending on the problem they perceive to be sorted. Patients also only know two places to access care their GP or A+E yet we persist in commissioning every alternative to prevent access to either. The role of the GP has grown organically and what is provided is determined by the provider. General practice at scale is a way of standardizing what is provided at the cost of continuity of care. It suits some doctors to work in a salaried shift system for others it is the continuity and relationship of the fixed list, cradle to grave responsibility that matters. The business models are flawed to provide the NHS because it is a socialist ideology. The public perceive it to be their right to access every level of care because that has been the political promise to them. What has never been discussed is how it is paid for and by whom. Rationing and co-payments started in 1949 which led to Bevan's resignation yet the mere mention of either is political suicide. There needs to be a proper conversation and a truly national standardized service where the public knows what is and is not available. The models that are being imported from the US don't take into account that they only work because the patients through their insurance schemes have personal responsibility to use their system appropriately or pay more. The insurance companies squeeze the providers so that care is rationed depending on the policy.

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  • well said Joe Macgilligan. There is a move to mega practices and the patients don't like large anonymous groupings. The modern NHS is so complex they need a friendly personal GP to help them navigate their way though all the fragmented services. Community services are a prime example. please could we have district nurses who are attached to the surgeries so that everyone can work as a team?
    We would lose most of our autonomy if we became salaried employees of such large groups and would live to regret it. Perhaps however part time GPs would not miss the autonomy as much as those for whom being a full time GP is a vocation in the traditional manner. Maybe it will all have to change as the full timers aged 50+ all retire and are replaced by part time GPs??

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