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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)

  • 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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