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NHS chief executive wants 'one-stop' GP practices to do 'all of the -ologies'

Exclusive NHS chief executive Simon Stevens has told Pulse that he sees a future where GP practices do 'all of the -ologies' currently done in outpatient departments, including things like cardiology.

Mr Stevens' comments are the first indication of the extent to which secondary care services may move into general practice, following health secretary Jeremy Hunt's announcement last month that they will be going through 'condition by condition' to see which can be handled in general practice 'one-stop shops' rather than in hospital.

Speaking to Pulse after NHS England’s 2016 Annual General Meeting, Mr Stevens said that he envisaged ‘cardiology, diabetology, all of the –ologies’ falling under general practice management in future.

He added that he wants to end the current system where ‘patients are sent off with a referral and the next contact comes when the GP receives a letter from the consultant’s medical secretary weeks or months later’.

And though plans are at an early stage, an NHS England spokesperson told Pulse that they want to ‘expand dramatically’ on models tested in NHS England new care model 'vanguard' areas.

This included an an east London ‘virtual outpatients’ model which has sought to reduce renal referrals as consultants give GPs input as close to real-time as possible.

It also included the East Hampshire MCP vanguard's pilot where consultant respiratory physicians attended asthma, COPD and breathlessness 'carousel clinics' across rural GP practices - with plans to roll out a similar model for diabetes building on work done in Portsmouth.

Clinical lead for the East Hampshire MCP Dr Kathryn Bannell told Pulse that, after nine months, 'the reduction in emergency admissions for asthma and breathlessness clinics was 100%' while for COPD 'the reduction was 55%'.

As the scheme is now set to expand, the MCP is considering using GP hubs to house clinics and having consultant input delivered remotely rather than in person.

Dr Bannell said: 'The hard data on outcomes from the pilot was absolutely unbelievable.'

An NHS England spokesperson said: ‘There are more opportunities to better integrate consultant outpatient services and the support offered by GPs, particularly for patients with long-term medical conditions such as diabetes, rheumatology and heart problems.

‘This is now happening in places such as Tower Hamlets, Portsmouth and Northumbria, and we now want to expand this dramatically.’

GPC deputy chair Dr Richard Vautrey said: 'Practices would welcome developing stronger links with their local specialist colleagues and sharing management in a way that reduced the need for patients to attend hospital.

‘But we need to ensure this is done in a way that doesn’t just shift more unfunded work on to the already over-burdened shoulders of GPs.'

The move to GP 'one-stop' shops

Speaking at the Best Practice Conference last month, health secretary Jeremy Hunt said that under his ‘GP one-stop programme’, the NHS will be going through ‘condition by condition’ to see which can be handled in general practice rather than secondary care going forward.

He said that he thought patients would prefer if their problems were 'sorted out inside general practice' and that's why they would look at 'what barriers we can remove centrally to allow more of this work to happen in general practice'.

He admitted that this meant asking GPs to ‘do more work’ but said that they would be ‘paid for doing that’ and argued that it would also ‘make life more rewarding for doctors’.

Readers' comments (37)

  • There won't be a general practice for the ologies to move into.

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  • Another swift kick in the ologies .

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  • "...reduce renal referrals as consultants give GPs input as close to real-time as possible"

    This actually seems like a very good idea given that most of my renal referrals are for CKD, and the consultant letter usually comes back saying little more than "please manage BP intensively and monitor renal function".

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  • Can I do the iamfekoffology?

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  • and the investment and resources for GPs is............?

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  • He must mean campanology......He must be ringing my bells

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  • Show me the money...

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  • I am all in favour of one stop shops, but patients will continue to consult us regarding the same problem(s) even after the consultation with the hospital doctor, whether that had been in hospital, over the phone / skype video, or in a community setting

    "These new pills make me nauseated, make me tired, make my periods heavier, give me aches and pains, haven't helped my back / neck / abdominal pain, make me depressed, cause ankle swelling , cause diarrhoea..."

    What we need is respite from the constant relentless complaints from patients.

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  • Dear Mr Stevens - The place you are thinking of is called a hospital. You'll find one in most major towns and cities in the U.K.

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  • We had all this with fundholding. Didn't work particularly well. It's amazing that these people get so excited when all they have done is reinvent an old worn out wheel. We already have an amazingly cost effective service. Looking to sped even less of a percentage of GDP is for the birds. This will come and go and they will then decide to centralise all these hubs because it will offer "unbelievable" savings.

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  • Centralise! Centralise!
    Localise! Localise!
    Plus ca change...

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  • This is trying to address the hospital tariff which is bankrupting the NHS and creating care silos. Meanwhile capitated funding has strangled primary care. There may be a better way, but we should all take a long look before we jump.

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  • Aren't there now more consultants than there are GPs?

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  • I've already been a houseman.

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  • Promotion to SHO

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  • Dr Bannell said: 'The hard data on outcomes from the pilot was absolutely unbelievable.'

    No dear, actually it's called 'regression to the mean' and can be observed if you take any outlying measurement, be it the top 10% of admissions or the worst performing cohort at a school , and then remeasure it. The group will always now be newer the average.

    This is statistical phenomenon and not a treatment effect. This is why the medical profession insists on randomised controlled trials.

    I despair.

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  • 10:39 - spot on!
    And while we're on statistics, how many of these ludicrous wheel reinvention schemes does it take to get another dozen GPs to despair and leave?
    What's the Number Needed to Harm for barmy new initiatives?

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  • 20 years ago we had community clinics under fundholding and we could also ( shocker!) ring our hospital colleagues directly to discuss a patient. Faster, cheaper and better for everybody.
    The government put paid to this with "competition" and "payment by results/activity" so that hospitals told their consultants not to speak to is and community providers told district nurses to ignore is.
    The results of this misguided approach are very clear.

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  • " Simon Stevens sees a future ". He is wrong there is no future for general practice . Only a rapid decline unto dusty death.

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  • Can't wait to carry out radiology in surgery....safe, isn't it!?

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  • A similar system has existed in Sweden for years. They are in as big a financial mess as we are.

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  • Is this an excuse to try to find a reason to close all the smaller NHS hospitals down?

    The thought of having to deal with vast amounts of extra consultations at a higher more complex level will also drive the few existing gps away. Who could afford this increased indemnity?

    So if this came to pass bingo no NHS!!!

    I think Hunt will be trying to implement this as soon as he can before the GP system collapses and he can not use them as a legitimate place to divert the expensive consultant's work in order for him to close down the hospitals the endangered consultants work in.
    He is a clever boy that Hunt!

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  • Hey guess where this is heading
    After a bit each GP will learn how to correctly manage this and that
    No bad thing in itself of course but once again
    it's politicians not respecting what GP's
    DO !! with their time
    Oh sorry that will be done by nurses
    One more ( possibly the last) nail in the coffin
    of what makes General Practice a worthwhile
    career choice
    Oh sorry we are all failed Hospital doctors
    are we not I forgot

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  • How about a new game. Wait to hear about any new health announcements and then guess the underlying reasons behind them.

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  • Last time I tried to bring some secondary care into my rural surgery I was told by senior nhs managemeant that it was too inefficient and led to inequality.

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  • Been there - done that - back in the 1990s. It was an inefficient use of resources then and will be again now.

    We are short of all generalists - not just in primary care. Having your local chest physician (for instance) traipsing from centre to centre where he or she cannot supervise their team, deal with emergencies or have immediate access to imaging is incredibly inefficient.

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  • Stevens is a disingenuous fool. Doing the ologies in Primary Carer-yeah, right.Most GPs cannot even read an ECG for themselves with any degree of confidence so cardiology provision will be wonderful.
    I've have worked as a GP for too many years now and the ability of most to do anything beyond the most superficial level is sorely lacking. This, I believe, reflects the broad but shallow training GPs have which, when presented with a proper-ology case, will be found to be lacking.I also feel that in order to have a workable system where such a hitherto faulty vision may work would require a collaborative effort of say a number of doctors who have for example MRCP, MRCOG, FRCS, MRCPsych etc between them. Stevens, apply your critical faculties, and try opening your eyes, before spouting such empty rubbish.

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  • asking a consultant to come to a gp practice is gross misuse of time. other practices suffer. in fund holding days bigger practices had lot of money and could purchaser this. others suffered.
    are they trying to make gp practices as one cottage hospital as it used to be 60 years ago and close down small practices?? i think so.

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  • We already do all the ologies, fool. Until we reach our competence and/or resource limits. Then we refer.

    Would you like us to act beyond our competence? No.

    Would you like to increase resource? (Meaning manpower as well as money). Super.

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  • So Simon Stevens and Hunt, both non clinical professionals are going to go through the ologies one by one to decide which can be managed in GP practices by a remote clinician?
    This is a clear example of how expertise has been downgraded in decision making and is very dangerous indeed.
    Everyone with any knowledge about it said that Lansleys reforms would be a disaster. They still ploughed on. Can't see any hands held up or responsibility taken for that.
    Rather than stepping back and wondering what went wrong they are just ploughing forward into anoth balls up. Ultimately it doesn't matter if you are running Sainsbury's. It kind of does matter (more) if you are running healthcare.
    Get out and work privately. You can work to your own moral and professional ethical standards and not to the current distorted ones.

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  • I knew it. Always knew it.
    We GPs only mange 90% of all consults on 5.5% of the budget [ in NI].
    So then, we should be able to manage, for starters, 95% on 5.8 % and 99% on 6% of the current budget.
    But, with the current Contract, even that is not needed.
    We can do 99% on 5.5 %, as they will never give us any extra money.
    They will have physician assistants, specialist nurses, pharmacists etc, but no money for the mugs [ that is us, by the way].
    So since we are not all completely thick [ sometimes they mix up our caring ethics with stupidity = like who would do 50 % more consultations on 50% less funding? ], there will be a few very altruistic GPs left.
    And the patient's charter says, they are entitled to another opinion [ I know it takes several years here].
    But never mind, I am leaving anyway.

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  • Time to return from cuckoo land to mother earth.

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  • We need the money now . Without funding all is ephemeral crap . Primary care needs a massive injection of liquidity if it is going to function in this way . Someone earlier in the thread said do the math . At present nothing adds up.

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  • 824
    ALL the 'ologies', urgent HV, STP, as they keep decreasing pay : either we are remarkable or plain stupid.
    I am joining you. I cannot cut the mustard anymore either

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  • Dear Jeremy Hunt and Mr Stevens, Where are the GPs, where is the time, and where is the money coming from ??
    looks like you are dreaming about implementing something like junior doctors contract!!
    wait, wait!. Think about manpower. Already you are scaring younger generation from joining medicine, those who are in the profession do not want to pursue general practice, who are already practising can't wait to retire.
    So what is your plan about manpower?

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  • The answer is in the article,
    Dr Bannell said: 'The hard data on outcomes from the pilot was absolutely unbelievable.'

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  • Thirty eight years ago, I joined a practice where we did almost all of the 'ologies, including all hospital services, even some surgery. We had inpatient beds, a maternity unit, and a scattered group practice reaching across twenty miles radius. Strangely, our outcomes compared favourably with other areas, and patients could usually see the doctor of their choice within three days.
    We were well supported by consultants in the nearest DGH (200 miles away) who visited regularly, and we were unconstrained by targets, QOFs or revalidation. Complaints were very rare. Our costs were very, very low.
    Over the years, recruitment became harder as training became more formalised, and those prepared to work in flexible ways even rarer. General practice became the home of non-emergency, chronic disease management, and the excitement went out of it. The challenge now is merely to keep going under an intolerable burden of routine and trivia.
    My daughter is a paramedic advanced care practitioner, and she sees the exciting and challenging patients, without the item of service concerns, and her targets are about rapid response and favourable outcomes, not asymptomatic blood pressures and weights recorded. Of course, she doesn't get the money that GPs do.
    The writing was on the wall for general practice from the contract changes at the end of the '80s, and I was happy to change career in the early '90s. GPs have taken the downhill path for thirty years and it has now caught up in the worst way possible. For too long, the Departments of Health, and the Royal Colleges, followed a mantra of sub-specialisation and standardisation (usually to the LCD), instead of celebrating variety where it suited local needs. Recruitment and training are now at such a low ebb that it is probably unrecoverable, and Cameron's promise of 5,000 more GPs is likely to become 1,000 less. Which of our profession's leaders have stood up and said this to the voters? Who has acquiesced in the dumbing down of general practice? I am guilty; I left rather than fight. What did you do?

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