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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)

  • Dr Dean Eggitt

    Complex care practices already exist. They are called hospitals

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  • Brilliant!
    500 high demand/need patients as opposed to 1900 on a regular list-the majority of which see their Dr every few years if at all!
    I reckon maybe 100 patients take up most of my clinical time already!

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  • It is my opinion that most GPs are not likely to wish to become full time geriatricians !

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  • Vinci Ho

    I would prefer more consultants actually work and base in community. Leadership and education are more important to community MDT team ( already including GPs).

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  • Why can't we just have well-trained general internists (like they have in Europe, Asia and the US) and hospitalists (like they have in the US) to work with patients with multi-morbidity?

    Neither the super-specialised hospital specialist nor the simplistic QOF-scoring, tickbox approach of the general practitioner are appropriate for the care of people with multiple complex conditions.

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  • The powers that be want to dump it onto GPs because of our comparative costs compared to our hospital bretheren.We see 90% of patient contact for 10% of the cost.The deluded fools in power seem to think we can cope with multimorbid patients.Done properly it will cost a lot more and need a lot more resources in the community.The cupboard is bear,of money ,of resources and very soon because of this lot man power.Let them have ther fantasies,they will come to nothing.Let them try to reinvent the wheel.Patients are now falling through the fragmented crack appearing in the current NHS model on a regular basis in primary and secondary care.The deck chairs are still being rearranged as the ship sinks and as a lot of our best medics primary+ secondary care jump ship to retirement/Australia etc.Sadly I wish I was one of them at the moment but Im not old enough to retire But am too old to emigrate.Good luck to everyone.

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  • Dr Mustapha Tahir

    How about special Practices for The Heart-sinks? May be a maximum of 50, with 5 full time Partners devoted to them? Surely many GPs will welcome at least one such Surgery per CCG cluster!

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  • I would not wish to lose complex patient care - often the most challenging and the most rewarding and, as actuually ill, not heartsinks. Bring back the visiting geriatrician service - would be used infrequently, would potentially keep folk out of hospital and would hel mainatin GP skills.

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  • Martin

    Great idea, but who will take care of the so called non complex patients. Many opportunistic diagnosis takes place when patients attend for "non complex" visits.
    Also the UK primary care workforce does not have enough qualified nurse clinicians or other practitioners to work with Gps in looking after acutes. These colleagues may have independent prescribing rights and may be very good at identifying and treating acute conditions, but will never take full responsibility for their patients nor do they have the qualifications and knowledge to address broader Healthcare needs and will only feel comfortable in working with a GP who the buck often passes into when things go wrong .

    I am aware that you have been appointed into this new role and you want to make your mark, but making a statement such as what you have simply causes more turmoil with some half baked civil servant or politician thinking that is a great idea and making further nonsensical changes to the GP contract .Do not destroy one of the biggest assets that the NHS has which no other country can boast about - NHS general practice that is still the most cost effective healthcare service (per episode of care when compared to community services or hospital services).in most areas the health communities cost to see a GP is cheaper than going to A&E, all secondary care out patients , a Physio, audiologist, District nurse or community matron episode).
    Rather increase the number of community based hospital consultants who would be able to be based in the community with their GPs and would be able to even more effectively manage Chronic Diseases. Cheaper to have our Good consultant colleagues In the community rather than in the ineffective Acute Trusts system that currently chews up PBR tariffs ineffectively.

    Please think carefully before making such statements and consult with frontline GP colleagues rather than far removed academics !

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  • I cannot see 40+ high complexity patients per day
    How many does a consultant see per day for his/ her own specialty ONLY not the multi pathology we as GPs are doing?

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