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At the heart of general practice since 1960

Political developments affecting primary care

Our handy revision notes

to simplify

your exam preparation

Overview

The NHS Plan1 has driven the biggest shake-up of primary care for 50 years, acting as a blueprint for changes in GPs' professional and personal lives. It is too early to know whether the advantages will outweigh the disadvantages, but the examiners will expect you to be able to debate these.

NHS Plan (2000)

The Department of Health states: 'This radical action plan for the next 10 years [sets] out measures to put patients and people at the heart of the health service.'

Main changes to the organisation of health services include:

l Increasing capacity

l Moving power to the frontline (local delivery plans)

l Introducing independent inspection

l Working in a more open way

l Moving money in line with patients' choices

For general practice, the key priorities and targets for the next three years are:3

1 Improving access to all services through: better emergency care, reduced waiting, increased booking for appointments and admission, more choice for patients

2 Focusing on improving services and outcomes in: cancer, coronary heart disease, mental health, older people, improving life chances for children

3 Improving patients' overall experience

4 Reducing health inequalities

5 Contributing to the cross-government drive to reduce drug misuse

GP access4

Advanced access requires appointment with a health professional within 24 hours and with a GP in 48 hours

Advantages

l Patients are seen more quickly

l Fewer complaints

l Active management and triage ensures patients see the most appropriate health professional

l The 'emergency' doctor can cross-cover for partner absence

Disadvantages

l Does not discriminate between medical and 'consumer' urgency

l Triage is a high-level and expensive skill

l Relies on 'clearing the backlog' ­ this can build up again when doctors are on leave

l 'Access'/primary care incentive money cannot be spent on additional doctor time

l PMS practices can be funded for additional salaried doctors; GMS practices are not

l More urgent slots may mean fewer 'book-ahead' appointments causing problems for chronic disease, the elderly and people who work

l May change threshold for seeking medical advice

l Threatens continuity of care

l Achieving PCT targets may not be money well spent

Targets: national service frameworks,9 Cancer Plan,10 waiting times11

Advantages

l Important diseases such as cancer, diabetes and heart disease are prioritised in terms of resources and training

l Desired outcomes are more likely to be

achieved

l Improved professional satisfaction

(job well done, creation of 'GPs with

special interests')

l Improved consumer satisfaction

l Better value for money?

Disadvantages

l Infrastructure for delivery ­ staff/plant/training/ resources ­ not fully in place

l Achieving targets may distort other clinical priorities and resource allocation

l Extra managers required by PCTs and practices

to monitor performance

l Some interventions not evidence-based or

'real world'

Walk-in clinics/NHS Direct4,5,6

Advantages

l Access to medical advice when and where people want it

l May relieve pressure on or work in partnership with GP surgeries and A&E

Disadvantages

l Loss of continuity of care ­ see advanced access

l Patients referred/self-referring on to GP or hospitals, whether appropriately or not, increase overall consulting costs

l Resources switched from GP services; value for money not yet established7

Electronic patient health record8

Advantages

l Any health professional can access the whole record ­ improved quality of care

l Costly delays and duplication avoided

Disadvantages

l Quality of data entry ­ miscoding, omissions and so on

l Security, confidentiality and civil liberties issues ­ patients may no longer trust doctors with

relevant information

l Doubts over computer system ­ GP systems far ahead of rest of NHS

l Cost

l GPs lose control over their own records

l May eventually be used as a stick

References and websites

1 The NHS Plan (2000) www.doh.gov.uk/nhsplan/index.htm

2 The new GP contract www.bma.org.uk

3 NHS Plan ­ the next three years' priorities and planning framework, 2003/6

www.doh.gov.uk/planning2003-2006/maintext.htm#1

4 Achieving and sustaining improved access to primary care www.doh.gov.uk/pricare/

improvedaccess.htm

5 Developing NHS Direct ­ a Strategy Document for the Next Three Years www.doh.gov.uk/developingnhsdirect

6 NHS Direct website www.nhsdirect.nhs.uk

7 NHS Direct in England (2002) National Audit Office www.nao.gov.uk/publications/nao_reports/01-02/0102505.pdf

8 Electronic record development and implementation programme ­ Frequently Asked Questions www.nhsia.nhs.uk/erdip/pages/

faq.asp#targetser

9 NSFs ­ National Service Frameworks ­ national standards for CHD etc www.doh.gov.uk/nsf/nsfhome.htm

10 NHS Cancer Plan (2000) www.doh.gov.uk/cancer/cancerplan.htm

11 Department of Health Waiting Times Statistics www.doh.gov.uk/waitingtimes

12 Primary Care Workforce Planning Framework www.doh.gov.uk/pricare/pcwpf.htm

13 Improving Working Lives Department of Health website www.doh.gov.uk/iwl

14 Unfinished Business: Proposals for Reform of the Senior House Officer Grade (2002) www.doh.gov.uk/shoconsult/index.htm

15 NHS complaints www.doh.gov.uk/complaints

16 Appraisal and revalidation ­ GMC/Department of Health websites www.revalidationuk.info, www.doh.gov.uk/gpappraisal

17 GMC Good Medical Practice 2001 www.gmc-uk.org/standards/good.htm

18 Clinical Governance www.doh.gov.uk/pricare/clingov.htm

(websites accessed September 14, 2003)

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