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London practices should work in federations, says King’s Fund

London’s GP practices should consider operating in federations, while many premises in the capital are not fit for purpose, says a leading health think-tank.

The King’s Fund and Imperial College London study said it found significant variations in the quality whilst carrying out a major research project into primary care in the capital on behalf of NHS London.

It said London GP practices could move more quickly towards different models of service provision such as operating in federations or networks to enable smaller practices to retain a local focus but provide a wider range of services.

The report added that while there has been investment in new facilities, some practices continue to operate from premises that are not fit for purpose.

It also said the GP workforce is older in London than elsewhere, with a quarter of GPs aged over 60 in some areas - raising staff recruitment and retention issues.

Finally, it said since almost 20% of London practices are single-handed, compared with just 13.8% across England, the practices tend to employ fewer practice staff which may limit what services the practice can offer.

The report says that to remedy issues, GPs should work more closely with hospitals, community services and social care to improve the co-ordination of care, especially for patients with long-term conditions, while London GPs and commissioners must make better use of data to understand and act on local variations in performance, and exploit the potential of IT.

The King’s Fund said: ‘In the coming years, London will face a growing health challenge as a result of an ageing population and unprecedented financial pressures. The report argues some practices in the capital are not equipped to meet this challenge.’

‘While on some measures Londoners are healthier than people from other parts of the country, widespread inequalities exist, with life expectancy varying by up to nine years and infant mortality three years between different parts of the capital.’

Anna Dixon, director of policy at The King’s Fund, added: ‘While there are some excellent general practices in London, the quality of care that Londoners receive is not as consistently good as it could be. There is huge potential to make better use of information and data to understand and address variations in performance. I hope this report will encourage GPs to engage in a discussion about how to lead a transformation in general practice to ensure all Londoners enjoy the best possible health care.’

But Londonwide LMCs, which has produced a response to the report, warned that the report may put too much pressure on GPs alone and needs to be matched by investment in primary care.

Dr Michelle Drage, CEO of Londonwide LMCs, said: ‘There are a number of positives in this report, but sadly most of these are obscured by the focus on the national average, as opposed to comparisons with other large cities that face some of the same diverse challenges as London.  The report is too quick to jump to  yet another system re-design solution, rather than building the positives and successes of the existing model, and how with the right support, improvements would deliver  even better outcomes for the Capital’s patients – a strategy for which Londonwide LMCs has a clear vision to share.’

It comes as last week, The King’s Fund said that across England NHS is performing well, but a focus on the move to CCGs could undermine the ‘fundamental change’ needed to improve the service. In its report on the coalition Government’s achievements in health policy, the King’s Fund warned there were ‘treacherous waters’ ahead and that organisational change was not enough.



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