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Independents' Day

A simple solution to take the pressure off GPs

Dr Nav Chana

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With the current pressures on primary care, it needs to be more efficient. One way to achieve this is to embrace the Primary Care Home, a new model of care that allows greater collaboration between primary care providers and makes the system work better for everyone.

Efficiency is also a goal of NHS England, who has tasked healthcare providers with working together to create their own unique outlines of a totally new system of care. These outlines, known as Sustainability & Transformation Plans (STPs), are designed to make the NHS more efficient by better spreading the load of demand across sectors.

However, the STPs that have been published already highlight some of the problems that stand in the way. Specifically, they all outline the need for primary care to become more efficient and tackle capacity issues if it’s going to take on work from the acute sector and support it in dealing with the increasing demand of a growing and ageing population.

In response, the National Association of Primary Care (NAPC) has developed a new model of care, called the Primary Care Home, that primary care providers can easily adopt to meet the goals set out in the Five Year Forward View and to better shore up the general practice base.

The Primary Care Home is designed to not only encourage but also expressly enable collaboration between different kinds of primary care providers in a local area. By creating a close working relationship between community services, nursing homes, community pharmacies, mental health workers, voluntary organisations and, of course, GPs and hospitals, patients are empowered to see the right person and receive the right services from the word go. This frees up GPs’ time while providing better care for the community.

It sounds simple because it is. Over a large population, small changes make a big difference. By cutting out all the unnecessary emails, phone calls and referrals for a registered population of between 30,000 and 50,000 people, the load can be spread more efficiently, affording primary care providers more time to take on work from the acute sector.

The NAPC tested the theory at 15 sites across the country and they’re all reporting good results. One site, for example, employed Musculoskeletal Disorders and Dermatology specialists as part of its first-contact care team. In just under a year, they’ve prevented 70-80% of the patients that came to see them from ending up in hospital.

In the future, primary care can go even further to support the acute sector. Efficient service is one thing, but if it could take actual procedures away from hospitals, the pressure on the acute sector would be reduced and patients would be seen closer to their homes.

Of course, the obvious problem with that idea is one of capacity; most primary care providers couldn’t do endoscopy procedures on site because they simply don’t have the facilities. But by embracing another element of the Five Year Forward View, namely flexible infrastructure, they can.

As long as patient safety is ensured, primary care providers can use mobile facilities to increase their range of services at times of high demand, truly spreading the load between primary and secondary care.

The primary sector needs to become more efficient to meet the needs of the population and support the changing face of the NHS, but the way is already being mapped out. The NAPC’s Primary Care Home model is the first step and it’s designed for ease of implementation. Once providers are working together, flexible infrastructure can take them to the next level and ease the pressure on the acute sector and the pressure on GPs.

Dr Nav Chana is chair of the National Association of Primary Care (NAPC) and a GP in Mitcham, south-west London

This is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at

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Readers' comments (11)

  • National Hopeless Service

    Can someone please explain to me in simple terms how general Practice is deemed inefficient? Its underfunded not inefficient. Slovenia invests more GDP into healthcare than the UK. What Dr Chana is proposing is cheap secondary care not efficient primary care. And if secondary care can be made cheaper why are most hospital trusts in deficit?

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  • Another yes man,how high can you jump!The NHS is underfunded and imploding.More BS to add to the pile.We are now at the bottom of the league for most things in the health league collaborating with the government with this rubbish WILL NOT improve our position just hasten the end.

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  • that does Not sound simple it sounds like what we've been trying to do for years, so it sounds good,yes but not simple..except I don't want more time to 'take more work on from the acute sector'-we need it to do the unmet need for primary care work first,and I want the nhs to provide acute care in experienced acute care settings for my friends and family when they need it.

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  • Cobblers

    "For every complex problem there is an answer that is clear, simple, and wrong".

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  • Peter Clayton

    We now deal with 90% of consultations with only 5% of the money. We need more doctors, less targets and meetings and so less firefighting and more manageable care.

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  • I have the greatest of respect for Nav as he was my VTS course organiser and inspired me to follow in his footsteps to become a Trainer and then VTS course organiser.

    My biggest concern about all this care being shifted into the community is that of responsibility and liability.

    We will need to live in a completely different medico-legal world if practitioners such as physiotherapists and mental health workers are allowed to make completely independent decisions without a doctor downstream to take the responsibility.

    The current situation is that hospital doctors pay very little indemnity because they are covered by Trust crown indemnity. Will the Trust still cover them when they are out in the community and supposedly supervising other health care professionals? I very much doubt it.

    Everyone is running scared and covering their own arse. When I am on call on a Friday evening, I have a steady stream of calls from psychologists just wanting to "inform" me that my patient expressed suicidal thoughts in a counselling session or a social worker letting me know Mrs B is "vulnerable".

    I'm afraid all I can see from this shift of work, is the shafting of GPs.

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  • Somehow words "working at scale" and "at pace" cannot be found in this article.

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  • Vinci Ho

    Said it before , say it again:
    Second Law of Thermodynamics explains that it is impossible to convert heat energy to mechanical energy with 100 percent efficiency . There is always a 'ceiling' of the highest efficiency you can possibly get and some energy is always wasted (entropy). You cannot get anything out of this wasted energy. This is science as well as philosophy about the nature and our universe . Hence , you will have to input more energy(resources) to get to a 'higher and better' level .

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  • Vinci Ho

    And the equation of resources (R )is:
    R=Money + Manpower+Expertise +Time with all four must be present, one for all , all for one

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