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Jeremy Hunt suggests GPs should have ‘their own lists of patients’


Jeremy Hunt suggests GPs should have ‘their own lists of patients’


Health secretary Sajid Javid has said GPs having their ‘own lists of patients’ would be ‘a common-sense approach’, following a suggestion by his predecessor Jeremy Hunt.

Mr Javid was giving evidence to the House of Commons Health and Social Care Committee when Mr Hunt raised two recent studies highlighting clinical benefits from continuity of care.

This week, the British Journal of General Practice published a study which found seeing the same GP significantly prevented polypharmacy, complications such as delirium, as well as emergency admission in patients with dementia.

Meanwhile, a Norwegian study, published in the BJGP in October last year, found long-term continuity of GP care to be ‘strongly associated’ with lower mortality, reduced need for acute hospitalisations and reduced use of out-of-hours services in the general population.

Addressing Mr Javid, Mr Hunt highlighted this week’s finding that dementia patients had a ‘35% lower chance of getting delirium’, and the ‘enormous study’ conducted in Norway ‘said that if you have the same doctor, the same GP over many years, you are 30% less likely to go to hospital and 25% less likely to die’.

He asked Mr Javid: ‘When you look at potential reforms for the NHS going forward, will you consider whether – as we increase GP numbers – we could go back to GPs having their own lists of patients as they used to, so that everyone has their own doctor?’

Mr Javid responded that ‘to me instinctively it sounds like a common-sense approach’.

‘It has to be the case, that if you are able to see the same GP regularly, as he or she learns more about you that they could better look after you.’

But he added: ‘Now I couldn’t make a guarantee that we can do that. I think primary care, there are a number of issues that we need to look at to make improvements for patients, but that should certainly be one.’

The purpose of the hearing was to gather evidence for the health committee’s ongoing inquiry into the future of general practice, which it has declared is ‘in crisis’.

Mr Hunt’s questions come as his own flagship policy for every patient to have a named GP – introduced during his tenure as health secretary with the 2014/15 and 2015/16 GP contracts – were found by researchers to have failed at improving continuity of care.

A study review published in the BMJ Open in 2019 found that continuity of care did not improve, and hospital admissions did not decrease, calling for more ‘sophisticated’ interventions to be made instead.

In fact, the number of patients who were able to see their preferred GP fell by 27.5% between 2012 and 2017, according to a University of Leicester study published in 2018.

Reacting to Mr Hunt’s new suggestion for improving continuity, Liverpool LMC secretary Dr Rob Barnett said ‘the way a practice operates in terms of providing care to patients’ is ‘more important’ than a GP having their own list of patients.

He told Pulse: ‘We are working in an environment whereby GPs are working 10 sessions a week. So I don’t know how practical it is always to say you can only see a particular doctor.’

He added: ‘From my perspective it’s not about GPs having their own list of patients, I think that I’m comfortable with a list being held by a practice, what’s more important is the way the practice operates in terms of providing care to patients.

‘So you don’t need to have an individual list to be able to have a system whereby continuity of care is provided to patients in practice.

‘In my own practice, patients indicate who they want to see and therefore there is continuity of care. So if a patient always sees Dr A, and wants an appointment with Dr A, they’ll get an appointment with Dr A.’

Dr Barnett added that he doesn’t find Mr Hunt ‘a natural ally for GPs or general practice’ but that maybe now he chairs the health select committee ‘may he now looks at things slightly differently’.

Kent LMC chair Dr Gaurav Gupta said: ‘The difficulty that we have in providing continuous care is workforce shortages. We have decreasing GP numbers year on year. And we know that there’s significant number of GPs now who are saying that they might retire in the next five years.

‘So I think we would like to provide continuity of care, but we need better workforce planning for that.’

Scope of the ‘future of general practice’ select committee inquiry

The House of Commons Health and Social Care Committee will examine challenges facing general practice in the NHS over the next five years, including:

  • access to services and the impact of changes introduced during the pandemic such as online or virtual consultations;
  • barriers to accessing services and the extent to which the Government and NHS England’s plans will address these issues will also be considered;
  • regional variation in general practice;
  • the general practice workload, and;
  • the partnership model of general practice. 

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READERS' COMMENTS [17]

Dr N 27 January, 2022 10:03 am

This is the comment of a totally clueless banker.

The Prime Minister 27 January, 2022 10:04 am

THESE PEOPLE ARE IDIOTS…..WHY DO WE EVEN GIVE AIR TIME TO IDIOTS…..THEY HAVE DESTROYED GENERAL PRACTICE AND ARE NOW “LEARNING” THINGS THAT A YOUNG CHILD COULD HAVE TOLD THEM……..THEY SHOULD BE CHARGED WITH “CRIMES AGAINST SOCIETY”

Turn out The Lights 27 January, 2022 10:12 am

We are losing 2 GPs from the workforce daily this will accellerate.Pie in the SKY from a party and 2 people that have directly led us to where we are.Too late to revers the damage you have and are doing.

ian owen 27 January, 2022 10:17 am

In an age where part time, salaried and/or locum GP’s doing so much work (not to mention the promotion of 24/7 availability) this idea might sound good in theory but is totally impractical. These guys need to think before they comment. It’s not even remotely connected to NHS current strategy

Vinci Ho 27 January, 2022 10:35 am

Agent Hunt is always proud of his ‘achievements’ as a health secretary. This is reminding people how good he was ( in contrast to the current Secretary of State ). The ideal concept of continuity of care is now totally wiped out by all previous messing around by the system in policies and further decimated by Covid 19 .
He is very careful in phrasing about ‘couldn’t guarantee now’ as he is sitting comfortably as the chair of the health select committee, questioning the incumbent health secretary. Having said that ,I think Rob is right about him looking at things ‘differently’ but that is certainly with a political motive playing the ‘good’ guy .
And we all know what his true motive is ……..😈

Bonglim Bong 27 January, 2022 11:39 am

If you want continuity of care how about:
– Valuing GPs and treating them fairly.
– Taking steps to retain GPs.
– Abandon the idea that other people (physio/ pharmacist/ etc) can easily do the job of a GP – as that has never really been the case.
– Remove pointless admin from GP
– remove workload dumping from secondary care from GPs.

There are plenty of more radical steps you could take – but starting with those listed above is pretty good.

Paul Hartley 27 January, 2022 11:59 am

Reinventing the wheel!
As though this was a new idea.
But certainly an opportunity for the DoH to create a new set of rules and directives to interfere in General Practice and have unintended consequences of making things very much worse.

Dylan Summers 27 January, 2022 12:03 pm

This might have been a reasonable idea when I started as a GP 20 years ago (though even then it wasn’t at all popular)

But how does it fit with increased use of non-medical practitioners? With flexible working patterns? With high levels of locum use? With triage systems? With extended access schemes? With out of hours and 111?

All travel in the last 20 years has been away from continuity of care. You can’t just turn round and say “every patient should see the same GP” when you’ve been reducing the possibilities for that to happen for 2 decades.

Nigel Dickson 27 January, 2022 12:15 pm

The best years of my GP career where the 18 years I spent as a single handed GP, my patients knew me and I knew most of them and their families. Patients who didn’t like me tended to leave the list and register elsewhere (to our mutual benefit) given I had a policy of never throwing any patients off my list (which you could in those days) – other than the odd patient who had assaulted me (bizarrely in those days in group practices they were not keen to remove patients who had assaulted me – partly why I left that practice). But all the time I was single handed those in authority and their chums in the media continually berrated single handed GPs for being in some way “sub-standard” and it was under Jeremy Hunts leadership that the idea of supermarket type super surgeries were encouraged and PCT money poured into these new enterprises, with see anybody, not necessarily a GP – a lot of them were staffed mainly with nurses with 1-2 nominal GPs for back up. Anybody and anyone was seen as being better than a good single handed GP. And now they are “inventing the bleed… obvious”. I’m glad I took early retirement. You couldn’t make this stuff up?

Rogue 1 27 January, 2022 3:24 pm

We were originally GP-patient list, then they changed to practice lists, Im sure we changed back to GP lists a few years ago (when J Hunt was around).
But as the partners all around are reducing their hours and going part-time it is becoming meaningless. We need to go back to small practice sizes (not mega surgeries), where patients are known by the people working there and not merely numbers.

Patrufini Duffy 27 January, 2022 3:54 pm

I suggest politicians need a proper degree and regulator. And prosecution.

Slobber Dog 27 January, 2022 4:33 pm

April the first has come early this year.

Nicholas Sharvill 27 January, 2022 6:12 pm

25% less likely to die’ Interesting advantage of having your named dr -immortality.
One assumes he means die early, though not quantified , which of course will always increase lifetime health care costs

C Ovid 28 January, 2022 12:28 pm

…but we all know this.

Question is how to do this in a sustainable way. In the 1990s this seemed about right in practices with about 6000 patients, probably 4wte and a sense of common purpose and risk. We all met for coffee, shared the workload and were able to discuss problem cases in real-time: this meant that continuity was partly sustained for when one of us might be on holiday. It’s just too late to put that genie back in the bottle now that we have Primary Care Fulfilment Warehouses instead. “Cashier number 3 please. . ”

hey presto 2004 arrives and the new contract (partly driven by colleagues keen to become mini chronic disease consultants), no out of hours and obviously we lost the need and ability to manage our demand proactively.

and then the neo-liberal bottom inspectors arrived. Outcome, Process, Reflection , Impact….Prof Patrick Deneen states in a podcast: “if you feel coerced to do your professional work by regulation, and not by love of it, then it will be sh*te” Hear hear.

C Ovid 28 January, 2022 12:40 pm

… as frequently quoted, the NHSsC has all the power, and thus all the responsibility. Literally, and in every way.

Sadly for them we are NOT bonded labour and we are no longer frightened by the stick. It’s carrot time folks.

Samir Shah 28 January, 2022 2:06 pm

This is nothing but lip service by those who continue to try to decimate General Practice for their own gain. Then they Thank GPs for all the hard work.

Dave Haddock 31 January, 2022 2:09 pm

RCGP has been undermining continuity of care for decades. Promoting “portfolio careers”, failing to train trainees to cope with full-time work, turning GPs into Social Workers with a medical qualification, undermining GP as a business, denigrating small practices.