GP leaders fear continuity of care eroded and family doctor role ‘dying’

GP leaders have expressed fears that the push towards working ‘at scale’ is bringing an end to continuity of care and general practice as we know it.

Speaking at a Westminster Health Forum conference on priorities for general practice today, GPC England’s deputy chair Dr Kieran Sharrock said the BMA is concerned that policy is moving away from ‘continuity of care’.

There is ‘very good evidence’ that continuity improves patients’ health as well as reducing costs, he added.

He told delegates: ‘The concern of the BMA is that new policy is moving towards at-scale provision [and] digitalisation and is not focusing on continuity of care when there is very good evidence that continuity of care with a clinician you trust and know – and more to the point a clinician who knows you and your family and circumstances – not only improves your health but reduces health costs.’

He added: ‘We have an increasingly unwell population who are getting older and have more long-term conditions and often those patients with the long-term conditions are in more deprived and less easy to access areas. 

‘Often they have less access to digital technology and therefore relying on new models of working that are at scale, that are not necessarily close to the patient’s home or through digital is more likely to disadvantage those patients who actually need the healthcare the most.’

This comes as ‘the situation in general practice is very strained’, he said.

College of Medicine chair Dr Michael Dixon added that GPs must work to ‘restore’ relationships with patients despite the ‘enormous pressures’ they are facing.

Dr Dixon, a Devon GP who is also national social prescribing network co-chair, said: ‘Our medicine during Covid has become more transactional, more episodic and developing relationships has become very difficult. 

‘We must restore these relationships and personalised care in spite of the enormous pressures that we are facing.’

One way to do this could be by dividing large practices into small teams so that ‘on any day’ there is someone patients ‘can identify with and feel that they are being looked after in a personalised way’, he added.

‘Social prescribing link workers will have an enormous role here because it enables them to spend considerable time with people in most need and often with complex problems and give that level of personalised care that for us GPs has sometimes become quite challenging’, he said.

Chief executive of Londonwide LMCs Dr Michelle Drage also told delegates that GPs are seeing ‘a march towards transactional care’ that has ‘no value to us as clinicians’.

And Watford GP partner Dr Simon Hodes said that health policy is slowly eroding continuity of care so that ‘the role of the family doctor is dying’.

He said: ‘If continuity of care was an evidence-based health policy, every politician of every cross-party would be jumping up and down to provide it. Sadly what’s happening is that continuity of care is being eroded by every health policy we’ve seen in terms of pushing us into ever-enlarging groups that are more and more faceless.

‘I think we’re saying farewell to the family GP – I’m turning 50 this year and feel like I’m in a real dying breed because I’ve been in the same place for 21 years. The amount of time I save by knowing my patients is priceless.’

In January, health secretary Sajid Javid said that GPs having their ‘own lists of patients’ would be ‘a common-sense approach’.

It followed a suggestion by his predecessor Jeremy Hunt, who raised two recent studies highlighting clinical benefits from continuity of care.

Mr Hunt’s 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.

It comes as the Mr Javid yesterday announced a new agenda for NHS reform, with GPs to be ‘at the heart’ of a new focus on prevention and new targets for a ‘radical acceleration’ of personal health budgets.