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A faulty production line

Complex care GP practices will 'bridge gap with hospitals', says NHS director

Smaller GP practices concentrating just on patients with complex conditions could bridge the gap between primary and secondary care, says NHS England’s long-term conditions tsar.

Dr Martin McShane, formerly a practicing GP in the peak district, told Pulse in an exclusive interview his plans for dedicated practices serving a list of around 400-500 patients drawn from local practices, which would receive more intensive care from a GP-led multidisciplinary team.

He said that these ‘complex care’ practice could offer much-needed opportunities for some GPs who might want to develop their skills and experience in caring for the most vulnerable and specialists looking to work in the community.

Dr McShane said: ‘If GPs want to step up to that and take that role, fantastic. And there are many GPs who would want to develop those skills and have the capacity and capability to deliver that service. But actually there may be people from [hospitals] who will see they could move [into the community].’

He added: ‘It’s about bridging the gap between the traditional role of general practice, which hasn’t gone away and has, in fact, become more complicated, and then this huge agenda of complex care.’

Dr McShane said the new enhanced service on unplanned admissions due to start in April would help to shift the focus onto complex patients, but stressed there was still a need to develop proper resourcing of dedicated multidisciplinary teams, with the medical profession at the helm.

He said: ‘If you look at what we’ve been trying to do, we’ve been nudging at this agenda, with community matrons, the Evercare model, with virtual wards and so on but the real thing that comes out of this is creating a proper focus with a registered list that you can build that team around.’

Readers' comments (11)

  • "creating a proper focus with a registered list that you can build that team around.’
    Yes, it's called a general practice.
    The implication of this is that patients will be forced/ encouraged to leave a GP who has known them and their family for years when their condition becomes complex. In my experience it is this group of patients who most value the long term, family orientated relationship they have built up with their GP. I can't imagine many patients wanting to do this......

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  • Why not just invest in existing practices properly. These mini-practices won't be financially viable. "Give us the tools and we will do the job"!

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  • This is a poor idea that will never happen.

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  • We have now seen over and over again that disinvestment in existing tiers and creating yet more costly extra tiers creates inefficiency and duplication and is not the best solution for the NHS.

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  • Pity the poor patient with multiple/complex chronic medical problems who will have to wait even longer to see someone who is a Specialist in those areas.

    GPs, even those in the proposed 'complex care practices' can not be Specialists in all areas required by this type of patient.

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  • We need more GPs so the average list size falls and we can give longer appointments to those who need it.

    It will need many more GPs. I cannot see it happening as the government would not fund it and even if they did, there are no more GPs to be had.

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  • usual silly idea from a recumbent position from someone who has moved to a cushier job..this idea has no will waste more time on reorganisation,lead to yet more fragmentation of care.
    the idea that a 'gp specialist' with no knowledge of a patient would manage complex patients better than a gp who has established an efficient therapeutic relationship is arrant and arrogant nonsense and betrays a worrying lack of understanding of the entire basis of primary care from an ex gp..mind you the same profound lack of understanding of primary care is common it seems in nhs england parliament etc.
    having fixed the primary health care team by destroying it ...the best policy would be to unfix what was never broken..Not to further 'fix' by damaging further the dysfunctional system created by previous evidence free meddling by fools with no electoral mandate to make such changes.
    what is needed is more resources for practices and most of all...MORE GPS...END OF

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  • If you remove the complex patients what is there left to do?Seeing snotty kids and signing sick notes all day long?It will devalue our profession and give further ammunition to the politicians and the general public who already consider us as overpaid and underskilled.

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  • I wish retired GPs would just do that. Go and mow the lawn please.

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  • Fully agree with this. Every practice can send off a small proportion of its patients who access services frequently to this service. It will have 2 groups of patients -those with truly complex illness and neurotics.
    CCG can fund them. Personally happy to give double the NHS fund back for 1% of our top attenders. Almost all of them have somatiization ,few have organic problems and somatization. True medical problems rarely require > 20 appts per year.
    Complex care is a new Euphemism for "neurotic".
    CCG`s can tender these to pvt companies. I sure Virgin et al can manage some of their infinite demand.

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