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Gold, incentives and meh

Government's flagship named GP scheme 'is not effective'

The named GP scheme has not successfully improved continuity of care or reduced emergency admissions, a study has found.

The scheme, which was introduced in April 2014 and was former health secretary Jeremy Hunt's flagship policy, assigned a specific GP for patients aged over 75 to be responsible for their care.

It hoped to provide more personalised, proactive care for patients and in particular improve continuity of care. 

Mr Hunt said the policy would mean patients would have someone to 'champion' their care and would correct the 'mistake' made in the 2004 GP contract which 'undermined' trust between a doctor and a patient. 

However, the study published in the BMJ Open, found that continuity of care did not improve, and hospital admissions did not decrease. It called for more 'sophisticated' interventions to be made instead. 

The study looked at 19,000 patient records in 139 GP practices in England and linked it with hospital data to compare their healthcare use in the two years before and after the scheme was introduced. It looked at results for those aged 75-84 and 65-74. 

It found that continuity of care decreased at a similar rate in both age groups after the scheme was introduced. Hospital admissions also increased in both age groups, with a greater increase in over-75s. 

Dr Peter Tammes, senior research associate at the University of Bristol and lead author, said: ‘The named GP scheme appears not to have delivered hoped-for results in terms of improved continuity of care and reduced emergency hospital admissions for older patients.

‘This suggests that the policy of allocating a named GP is not, in itself, effective and more sophisticated interventions are needed.’

A previous study in 2016 also found that the policy did not have an impact on continuity of care but the Department of Health at the time said it was too soon to write off the policy.

However, this new study called for alternative ways to improve care for older patients.

The study said: ‘Allocating a GP does not imply that patients are able to see or speak to that GP whenever they require advice or care since this depends on GP workload, practice opening hours, salaried and part-time working contracts.

‘A policy of allocating a named GP in itself is not effective and more sophisticated interventions would be needed to improve continuity of care in the UK or countries with similar healthcare systems.’

Dr Tammes also questioned how the scheme was implemented and whether it could have been improved had patients been given the option to decide who their named GP was.

He added: ‘We did not interview patients and staff about what they thought about the scheme, so our understanding of why it does not appear to have worked is therefore limited. We would urge policy makers to look at other ways of improving care for this older patient group, taking both patient and GP views into account.’

Dr Richard Vautrey, BMA GP Committee chair, said: 'We have seen a significant increase in demand on GP services since the named doctor scheme was introduced in 2014 and so it is no surprise that these results show a negative impact on continuity of care.

'With an ageing population continuing to place more and more pressure on general practice, the Government must work with doctors and practice staff to find other ways to improve care for these older patients and in turn help reduce some of the burden on GPs.'

It follows plans to overhaul NHS Health Checks in a bid to end 'one-size-fits-all' check-ups. A review will look at creating a more tailored check-up in order to better prevent and predict diseases. 

 

Readers' comments (19)

  • David Banner

    For the Named GP scheme to work you need stable thriving full time partnerships with partners spending their whole career working in the same practice .....you know, like the good ol’ days when everyone had “their” GP.
    But If you spend a decade running partnerships into the ground, leaving unstable practices staffed by part time salaried/Locum GPs (who quite rightly disappear every year or 2 when they are worked into the ground) then sticking a name on a record is the useless gimmick we all knew it would be.

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  • Well I am totally shocked that this top down and poorly thought out government initiative did not work.

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  • Quite accurate and succinct David Banner.

    27 years in my practice with individual lists and soon to be no more.

    Thanks to all in Government and NHS E and others.

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  • Well said David. Gone are the days when one could just visit a patient socially for a cup of tea and the friendly atmosphere where it is all about learning and improving care and errors are corrected in a non punitive way. Now it is all stick and about covering your back and answering complaints and NHSE, GMC over regulation and blowing things out of proportion. We have also lost the more relaxed atmosphere without all the box ticking and lost a lot of time attending useless meetings like the new PCNs.

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  • Vinci Ho

    You see
    (1) One thing Agent Hunt was extremely good at was ; NOT to discern the facts of the matter before applying his so called ‘morality and principles’ . He had zero understanding ( like many others ) of the meaning of Continuity of Care (COC) . Likewise , his infamous claim about more patients died in hospital if they were admitted during the weekend , precipitated the animosity against our junior colleagues.
    (2) If the ‘system’ only believes bigger is better , working by scale is better than traditional model , COC will be the casualty of this overcompensation for more demands in NHS with and without ageing of the population.
    (3) Letting the Babylonians to enter this battlefield makes the whole big picture even more ambiguous. Customers are replacing patients . Quantity replaces quality .

    As I always said , the government has a decision to make for the future . Of course , they dare not say they are forfeiting COC but we will always put these politicians on the spot ........

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  • Stop the press! Simple administrative task doesn’t result in massive improvements to patient care! Could have told you that years ago. It needs a properly funded primary care for continuity to truly work.

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  • The answer is more small practices..oh wait...although copying that small practice clinical model across larger practices (ie a clinical team of GPs Nurses etc caring for 4-6k patients like individual lists but not) may also be effective - just need someone to do it and write it up!

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  • Is that the thing that resulted in Care Plans and Proactive care? the box we tick automatically to Update? the thing that no one, not one doctor nurse or carer in any hospital hospice or practice has ever once requested or commented on? know what - I don't Care either.

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  • Has it really taken 5 years to work out that this was a waste of time? I'm sure most of us could've predicted the outcome within 5 minutes.

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  • National Hopeless Service

    I wish there was an NHS Greta Thunberg who could shout and scream at these moronic ideas from morons.

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