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.