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GPs could become ‘integrated care managers’ in future NHS

GPs could become ‘integrated care managers’ charged with navigating patients through the health and social care system, agreed a panel of GP leaders discussing the future of the profession at the Pulse Live conference.

As part of a discussion on where general practice fits into the future of the NHS, the panel agreed that integration of services was essential for the future of general practice and the health and social care services more widely, with GPs playing a key role as the gatekeeper to wider public services.

Mr Stephen Dorrell MP, chair of the House of Commons’ Health Committee said the health and social care system needed to be ‘reimagined’ so that patients can access the full range of public services such as social care, housing and education in order to help prevent and manage long term conditions.

He said: ‘It is a transaction-based system. What we actually need, and this is where the re-imagination process comes in, is a system that is designed for its core purpose. Its core purpose being to add value to extended life years.’

The role of primary care is to identify conditions earlier in their development ‘because often in the current system we allow a condition to develop until there is a crisis’.

He added that the evidence for integrated care is overwhelming, and that one of the most ‘undervalued’ elements of the Health and Social Care Act was to allow the health and wellbeing boards to bring together organisations to compel change.

He said: ‘There is evidence from Torbay, repeated elsewhere, that if you achieve properly integrated care, you reduce demand for hospital admissions or hospital stays. Joined-up care is better for patients because no one wants to be in an acute hospital and better for the taxpayer because you are quite literally getting more for less.’

Dr Pat Oakley, a research associate at King’s College London agreed integration of services is going to be essential in future. She laid out three goals for the health services: chronic disease management; improved clinical informatics and genomics, public heath gains and integrated care.

GPs could act as ‘integrated care managers’ to make full integration of public services a reality, she said: ‘We have to think about the mobilisation of taxpayers money to create local authority and public health strategies, create strategies for improving health gains and genomic strategies.’

‘This requires an integrated care manager which could be a GP, or could be situated in primary care. They would act as a locus or navigator for integrated care.

She added that the workforce has changed dramatically with more women joining general practice and the structure of work needed to adapt to take into account the changing role of the GP which will expand to offer near round the clock care in future.

She said: ‘Feminisation is fed through into the workforce and we must think, is the current model suitable for a female workforce? And what about the structure of the job? With 24/7 care and out-of-hour services, how will that look in future to fit acute care?’

Dr Simon Poole, chair of the GPC’s commissioning and service development subcommittee and a GP in Cambridge said he was ‘surprisingly and uncharacteristically optimistic’ about the future of general practice.

He said the essence of general practice that should be preserved was providing ‘long term, holistic family care in a community setting from cradle to grave, notwithstanding changes in the NHS’ and that it was the duty of CCGs and GPs to manage such changes to keep in focus what is important to patients.

He said: ‘We are sitting on a time bomb with diabetes and cardiovascular health. CCGs are going to need to invest for diabetes over five to ten years, and not just in the NHS, in social health.’

‘But there’s so much pressure to balance the books year on year that there might be no vision for the future. Sometimes the social factors for health are often more important than health and this is something we’re lacking in this country.’