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Continuity of care has worsened 'due to part-time GPs', says NHS England chief

Continuity of care has decreased in the past few years largely due to GPs 'choosing to work less time full time' in practices, the head of NHS England has said.

NHS England chief executive Simon Stevens suggested this was down to the NHS 'placing' more GPs in different NHS settings and denied that efforts to increase access to GP appointments had any part to play.

Meanwhile, he admitted access to general practice appointments had 'steadily' worsened for patients over the same time period as well.

At an event run by the Nuffield Trust think tank in Windsor, Mr Stevens was asked whether policies to increase access to general practice has been prioritised over continuity of care in the last few years.

He said: 'No, because I don’t think that is actually the explanation for the decrease in continuity. The decrease in continuity isn't because access has been prioritised or improved.

‘The patient experience of being able to get quick appointments at your practice has been getting steadily worse and we’ve got to turn that around.'

He added: 'The factor that most explains that continuity difference has been the composition of the workforce.

'In many practices the majority of GPs in their 40s or 50s are choosing to work less time full time, together with the cause that the health service is placing GPs in other parts of the service.'

Mr Stevens said there was a 'conundrum' in trying to provide continuity, alongside GPs being able to have flexible careers.

He suggested the way of ensuring better continuity of care was to focus on those patients who need it the most.

He said: 'How do you actually be a flexible employer, recognising that people will want different options over the course of their career, want to be at work part time, and give some version of continuity?

'There are a couple of ways into that. One of course is segmenting your patients at population for those for whom continuity actually matters versus those who are actually presenting in general practice for a one-off fix - and so in general we’ve got to be more differentiated.

'Even if it’s within the practice or the primary care network, the urgent care-primary care interaction isn’t necessarily the same as the long-term relationship and chronic disease management that some patients fully get. There will be crossover.'

Mr Stevens' comments come as the Government plans to expand its scheme placing GPs in A&E departments, after it claimed 10% of patients are now being diverted through the scheme.

NHS Digital data released yesterday shows the number of fully qualified full-time equivalent (FTE) GPs in England has dropped by 277 in the past year.

A report in March found the NHS will have 7,000 fewer full-time-equivalent GPs than needed within five years. 

The Conservatives have pledged to recruit 6,000 more GPs by 2024/25, although former health secretary Jeremy Hunt failed to deliver the 5,000 GPs promised in 2015.

Pulse revealed earlier this month that the Government could end up with almost 2,000 fewer fully qualified FTE GPs by the start of 2024/25 than in 2019, if the current annual rate of decrease in staffing continues.

Readers' comments (55)

  • Has he reflected and asked himself why? UK GPs are the most stressed and unhappy due to the over regulation and micromanagement by the government as well as a lot of other adverse factors. Work dump, CQC, GDPR, pay to work, pensions, Gross Negligence manslaughter to name a few.

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  • Try to actually ask people what is going on in the front line, rather than guessing from your ivory tower.
    People are working part time because those in power have made it almost impossible to work 9 sessions or more.

    Don’t just complain about the situation, do something about it. Perhaps a premium for working full time. Perhaps a commitment to pay all pension related tax from central government funds. Perhaps make working 5 days a week considerably less than 60 hours. Perhaps make it easier for small surgeries rather than massive groups.

    And almost by definition PCNs are designed to reduce continuity of care.

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  • You need to have relaxed and competent GPs for continuity to work. Just saying.

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  • 'Continuity of care has worsened 'due to part-time GPs''

    The clue is in the title, Smart Boy.

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  • What you also need is a resourced multi disciplinary team in each practice proactively managing the upto 5% of patients who are complex, housebound or terminally ill. This is the group that most need continuity of care from a clinical perspective.

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  • There is no conundrum regarding continuity of care and GP Career. The job is shite and the support is shite and varies daily regarding the depth of shite. The only person who cares is you is you!

    NHS E, CCG, CQC etc dont give a stuff.

    22 days.

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  • Simply hilarious, and I can only echo the statements already made...crap job, tax issues forcing reduced hours, work dump. Who'd want to work a 9 session, 50 hour week

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  • NHS England did not want or value continuity of care.

    The stated aim was larger, merged / federated practices. If a practice is struggling -merge it. Small practices with high continuity of care not valued.

    Spread the existing workforce over longer days, multiple areas and enforce attendence to outside meetings, PCNs -and this is what happens. No surprise.

    That is why continuity of care is going!

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  • Nob off and get us our PPE.

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  • The sad thing is that continuity of care makes for efficient consultations, reduces admissions and patients prefer it.
    Like everything , not valued until it’s gone.

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