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GPs could be asked only to focus on complex patients, suggests NHS director

Some GP practices could be remodelled to only focus on patients with the most complicated needs, under a radical new model of care suggested by NHS England’s director for long-term conditions.

Dr Martin McShane suggested that the NHS could only cope with rising numbers of patients with long-term conditions if GP practices were changed to become ‘complex care practices’.

This new model would mean that a multidisciplinary team led by GPs would hold a patient list, with less than 500 patients per doctor and additional resources drawn from primary care, community and the acute sector.

In a blog post on the NHS England site, Dr McShane admitted that GPs were struggling to cope with ‘massive increase in workload and a relative decrease in investment’ and that radical new ways of working were needed to bridge the gulf between primary and secondary care.

He said: ‘The generalist in the community and the specialist in the hospital have moved further and further apart. General practice has maintained its base, its key role in dealing with the chaos at the frontier land of health care. Meanwhile specialists have become more and more specialised (ask an orthopaedic surgeon which joint they specialise in!).’

He added that new models of care were needed to ensure that patients did not fall between the cracks.

He said: ‘One such model might be to establish “complex care practices”. Registered lists with a multidisciplinary team where the doctor has less than 500 people, but only people with the most complex care needs.

‘It could have a capitated budget drawing on the ineffective way resources are currently used for this group in the community and acute sector as well as the parsimonious amount invested in general practice.’

Readers' comments (13)

  • Has this bloke asked Pts if they would like that?

    I have several complex case patients whom I've know for many years and have a good doctor-patient relationship with, and I doubt many of them will happily travel the longer distance (as I assume there will be few of these super surgeries) to see a doctor they've never met.

    p.s. Most consultants can see 40+ highly complex patients/day Peter. I know this as my partner works with consultants. The difference is the support - consultants will have CSNs, junior grades, secretary supporting them, we have none.

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  • Thank you anonymous @ 1.39 p.m. - exactly the point I was going to make.

    Spare a thought for the multimorbid patients, who already have enough to contend with but who under this suggestion will presumably have reduced acces to a consultant with SPECIALISED knowledge. Sorry, but GPs are only specialists in diseases the government incentivises, they have no time to gain in depth knowledge in other areas. I'm sure patients will all be as dismayed by this proposal as most GPs.

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  • Anon 9:02
    Love it - too old to emigrate but too young to retire - approaching 50, that's me in a nutshell!
    We sure find ourselves in an unholy quagmire but it's the astonishing speed with which all this has happened. Final straw for me was seniority withdrawal and I suffer all this through no more than being an accident of the calender. I am seriously looking to recoup the pay stolen from me by the government through some tax free years in the UAE. The NHS seems to have months left in it - our so called leaders fiddle while Rome burns. RIP NHS.

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