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Patients don't 'trust' they will see their own GP, NHS England lead claims

The lack of continuity in GP care is resulting in too many patients attending A&E inappropriately, because they don’t ‘trust’ they will be able to see their preferred GP if they attend the practice, NHS England’s head of GP development has claimed.

Dr Robert Varnam, who is also a GP in Manchester, told delegates at a King’s Fund urgent and emergency care conference in London today that continuity and access were ‘inextricably’ interlinked, and that patients were less likely to reconsult when they had had access in the first instance to a GP who knows them.

But the GPC said demand for continuity was not universal, and said GPs should focus on providing continuity for patients with chronic illnesses to prevent them becoming urgent care cases.

Dr Varnam told delegates: ‘Just having more and more of something isn’t going to meet your needs. And so we see people getting more access to care, but then they reconsult somewhere else in the system very soon after because their needs haven’t been met.

‘We need to talk about right access to the right care, and that does include improving continuity of care: people able to see the person who knows them. They’re inextricably linked, they together make up safe, effective clinical practice.

‘And we need more of that, we do need to improve access. There are too many people who pitch up to a part of the system they themselves suspect is not the right one. But it’s because they don’t have confidence that they can get access to the person who knows them best.’

GPC chair Dr Chaand Nagpaul told Pulse: ‘I think that may be the case for some patients, but again, we need to see some data. Look it up, you see these gut reaction feelings we have aren’t matched by the stats and evidence.

‘So we have to be a bit careful around drawing too many conclusions for that, and for patients in urgent need, i.e. they’re ill, they’ve got a cough, a cold, a respiratory infection, acute abdominal pain. I think at that moment in time they just want to see a GP, they’re not looking at continuity.

‘Where continuity is important is with patients with chronic diseases. They may not be urgent care patients but patients who could need urgent care if they’re not managed optimally. But that’s not time critical. So we do need to enable GPs to provide continuity for those patients.’

Readers' comments (10)

  • continuity of care is one of the cornerstones of good quality primary care.

    However it is not compatible with part time working ( be it for family or CCG/Academic work).

    Large proportion of new GP's are hedging their bets, with 'portfolio'careers.

    Solutions should be to incentivise these elements and try and support primary care rather then the systematic undermining of it.

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  • what was the point of this artcle?

    that patients should see the GP that they want, when they want it, which will reduce A&E admissions?

    NHSE can bugger off if they think I've sticking around 24/7 for this crap.

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  • Took Early Retirement

    Hilarious! If I were suddenly ill, I would be very surprised to see my own GP. That wouldn't make me attend the ED.

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  • Patients would be more likely to see their own GP if they weren't too busy and stressed chasing appraisal/revalidation/cqc/qof etc.

    Free us from the admin and just ask us to look after the patients and suddenly you would end up with motivated, focussed GPs again

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  • nhse despises gps, wants to replace them with assistants paid at minimum wage, emigrate if you can

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  • Patients in my experience ALWAYS want continuity unless they mistrust the last person they saw. The challenge is delivering the benefits of a single handed practice with the resilience of a group practice. Decompensation of long term conditions is only one area where a closer relationship aids the clinical process, in fact it almost always aids diagnosis and development of realistic care and treatment plans. The biggest step would be to open ALL appointments for online booking, and improve access to avoid inappropriate A&E attendances

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  • Anonymous GP Partner 6.01 pm. EXACTLY! This is the only way forward to rescue General Practice as our patients want it to be and not some privatized salaried service.

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  • Ivan Benett

    Well done Robert. This might be the only voice supporting you, but you're right, just remember that. Access and continuity are indeed ‘inextricably’ interlinked.
    So is Chaand. Patients want continuity when they have long term problems, but for urgent or same day problems they don't mind (too much) who they see.
    In any case the profession gave up on continuity when we gave up 24/7 responsibility, as anon 4.59 pm so charmingly put it.
    PS access on it's own wont stop admissions, but it does reduce attendances. Continuity helps to prevent admissions - although this may be through infromational as well as relationship contiuity.
    It's an up hill struggle, but we're getting there, notwithstanding some of the comments anonymously posted here

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  • GP practise are forced to keep their books open which makes the demands for appointment greater and not enough to go around.

    Haz anyone thought of telling NHSE that there are only so many hours in a day and so many appointment slots that can be fitted in. Continuity of care means GP's see patents, not sit at a desk ticking boxes for the plebs in NHSE.

    Opening up all appointments 'on line' would not clove the problem, it often those that pre book in advance that become DNA's and what happens when all the online appointments are taken and someone needs to see a GP urgently.

    A&E should do its job and turn away time wasters, weekend drunks etc. Triage patients on arrival and send home those that are not an emergency … there fare plenty of those. Gibe the time wasters the 111 num,her and tell them to book an appointment with their GP via that service.

    The greatest misfortune is that GP's are mere human beings, they have families of their own, some are single parents, they need to eat and sleep … but apparently not to NHSE who happily closed down a week early last Christmas but expect GP's to work hop until the final minute of Christmas Eve.

    Perhaps NHSE can replace GP's with robots!

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  • The maths does not stack up, though. In spite of the vitriol that is thrown at GPs, what Robert is saying is that Secondary care cannot cope with 8% of consultations on 92% of the money, but want us poor blighters who do 92% of consultations on 8% of the budget.
    Even if Robert is right, there is absolutely no way any sane person can be available for 24 hours a day, 365 days a year, which is an absolute requirement for total continuity of care.
    Also and by the way, GP consults have gone up 100% with a 20% increase in GPs , compared to 35% with a 100% increase in A+E Consultants in 12 years.
    So Robert, the truth is we are far more efficient than you.
    One more thing, 25% of my Consults are patients for lack of secondary care provision such as appointments ie on long waiting lists. 10% of my Consults are A+E problems who do not go to A+E because they have to wait 12 hours to be seen.
    The maths is very interesting, but you need to stop to look at it, before pontificating as a whole bunch do, starting with our esteemed leader Mr Hunt.

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