NHS England should introduce a ‘national measure of continuity of care’ to be reported quarterly by all GP practices by 2024, say leading MPs.
A new report into the ‘future of general practice’ published by the House of Commons health and social care committee today also called for the restoration of individual patient lists.
And it issued stark warnings of a demoralised profession, with GPs facing burnout from working in a ‘systemically toxic environment’, with unsustainable workloads, managing intensely complex cases at speed with fear over reprisals.
The committee – formerly led by new Chancellor Jeremy Hunt – said it had ‘extreme concerns’ over the decline in continuity of care and that reversing this should be an ‘explicit national priority’.
But the Government and NHS England have been reluctant to acknowledge the crisis in general practice and must do more to set out detailed steps to address this, it added.
The report said: ‘NHS England should introduce a national measure of continuity of care to be reported by all GP practices by 2024.
‘The new measure should be based on existing models such as the Usual Provider Continuity index and the St Leonard’s Index of Continuity of Care and in the short term should be based on measuring either continuity delivered by a named GP (in pooled list practices) or by a personal GP (in personal list practices).’
It added: ‘The measure should be reported quarterly at practice, Primary Care Network and Integrated Care System level as well as nationally.’
The report recommended an ambition for 80% of practices to return to personal list continuity by 2027, with personal lists in the GP contract from 2030.
Consideration should also be given to limiting patient list size to 2,500, moving to around 1,850 over five years as more GPs are recruited, it said.
Following a detailed enquiry led by then-chair and now Chancellor Jeremy Hunt, the committee recommended that ‘GPs should be treated like professionals and incentivised to provide relationship-based care for all patients’.
Other recommendations include:
- The professional status of GPs should not be undermined by the inappropriate refusal of GP referral decisions
- A broader overhaul of primary care should include a dramatically simplified interface for patients who are often confused about whether to call the GP, out of hours, 111 or go to A&E
- A new funding mechanism should replace the Carr-Hill formula to better support access to general practice in areas of deprivation
- Urgent work is needed to stop a bidding war for the services of locums and encourage clinicians back into regular employment
- An additional 1,000 GP training places a year should be funded
- NHS England should take further steps to address the administrative workload in general practice
- Instead of hinting that it may scrap the partnership model, the Government should look to strengthen it because it is effective and efficient ‘if properly funded and supported’
- QOF and the Impact and Investment Framework (IIF) ‘have become tools of micromanagement’ which risk turning patients into numbers and should be scrapped
The report highlighted that in May this year, there were 27.5 million appointments in general practice – over two million more than in 2019 – but that while the number of registered patients has grown by 3.2% over the same period, the number of GPs working in the NHS had dropped.
‘It is time to recognise the need to make the job not just manageable but once again fulfilling and enjoyable’, with the professional status of GPs restored and ‘a decisive move away from micromanagement and short-staffing’, the committee concluded.
Health and social care committee member Rachael Maskell said: ‘Our inquiry has heard time and again the benefits of continuity of care to a patient with evidence linking it to reduced mortality and emergency admissions.
‘We find it unacceptable that this, one of the defining standards of general practice, has been allowed to erode and our report today sets out a series of measures to reverse that decline.
‘Seeing your GP should not be as random as booking an Uber with a driver you’re unlikely to see again.’
Professor Martin Marshall, chair of the Royal College of GPs, said: ‘Today’s report is long overdue recognition by influential MPs that general practice is in crisis and the Government must take note of its recommendations and act to address the intense workload and workforce pressures facing the profession as they strive to deliver care to patients.’
He added that urgent action was needed to recruit more GPs and retain experienced doctors in the profession longer.
He said: ‘The Committee’s report also acknowledges the importance of GPs and our teams building trusting relationships with patients and delivering continuity of care, something that evidence has shown improves patients’ health outcomes and has benefits for the NHS.
‘This is the type of care GPs want to give and the type of care many of our patients want, but amidst the current pressures facing general practice, is becoming increasingly difficult to deliver despite the best efforts of GP teams.’
The committee also found that the recent decision to introduce a two-week wait target for GP appointments will not address the fundamental capacity problem underpinning poor access.
And MPs said that the creation of primary care networks (PCNs) and the addition of new roles, while welcome, has not yet made a meaningful impact on the sustainability of general practice, the committee added.
READERS' COMMENTS [9]
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And the wheel turns
Interesting that MPs feel they have a role to play in addressing this issue, one wonders how much continuity they would provide if constituents had 24/7 access to political representation.
The most important MP of all, until this week from a health service perspective was Mr Hunt, now he is simply the most important MP. He believes in the power of openness, clarity shining a light on problems, and letting the public knowledge of the raw date do the job, put another way shaming poor performance.
Doctors include after their names many arcane, meaningless letters denoting membership pf colleges or academic qualifications obtained. Many years ago conjoint was shown to be the most impressive set of letters in the public view
Nowadays GP itself has become a meaningless term often confusing and misleading the public.GPs come in a bewhildering variety of sizes shapes and contractual commitments.
What if the term had to be qualified, GP salaried, GP locum, GP academic.
More importantlyy what if the term required specification of clinical commitment.GP one day week, two half days month, pops in for tea twice year.
Would the great and good be so public with their views if the true paucity of the basis were spelled out so explicitly
Eventually Mr Hunt might meet some clinical doctors who have actually seen some patients
A comitte chaired by Jeremy @unt.For Gods sake you were the main cause and the longest service SoS.It materisied on your watch.Did he keep a straight face while composing this.Not really bothered anyway as will leave my Senior Partners role beofre this materialises.
FFS; another “measure”, another target, another number to crunch.
Try this on for size.
The £1.6 billion PCN DES funding, set to rise to £2.8 billion by 2024; straight into core contract, no strings attached; that’ll help capacity-the only thing that will help continuity (the PCN staff that are useful; physios and home visiting paramedics-will be kept on; the rest I suspect will go).
NHSE can foxtrot oscar. Legislation has passed this year to move management back from centralised ie NHSE to local ie ICS.
Pray do tell why do we need a second mass management system that take practically double the entire primary care budget to do fuck all apart from obstruct any clinicians from getting on with their job as they best see fit.
We will have half of their budget; practically doubles primary care budget, social care can have the rest for council run home care teams; removes the 20% bed block = 20% more NHS beds = end of NHS secondary care crisis both acute care and elective backlog both seriously augmented.
No management consultant fee required for this reorganisation.
Just needs a government with a brain to sort out the monster quango NHSE, recognise they are the problem and get rid of them and redistribute their 15% of the NHS budget they cost.
It’s a fully costed plan; no increased spending on NHS overall. Surely someone can do this.
Your house is burning and surrounded by a forest fire and you are discussing whether to add a swimming pool and sauna.
🤔Hmm there seems to be a problem with targets and the excessive process and funding needed in managing this. 💡 I know let’s introduce another target and a whole new department for managing it. Problem solved home by 4 today🤦🏼♂️
Another report highlighting a ‘demoralised’ workforce and what do they recommend? More statistics?? How is that going to help? Just more ‘evidence’ to tell them what everybody already knows. And it absolutely makes my blood BOIL when I read comments from narcissistic idiots who think naming and shaming individual Drs to expose ‘poor performance’ by spelling out ‘how many sessions they are working’ or wether they are a ‘locum’ , ‘salaried’ or a ‘partner’ is anything other that a stupid vicious vacuous bitter navel gazing idea from someone evidently pissed off they are working more than the locums they have to employ , who evidently thinks these issues have something to do with the quality of care someone provides in a face to face appointment. Listen mate ..anyone who is qualified as a GP went to medical school just like you, they sweated through junior Dr hospital training, just like you, they are subject to appraisal, just like you and when they go to work they are confronted with exactly the same clinical dilemmas as you are, they have to make exactly the same clinical decisions as you do and they are just as likely (actually statistically more likely) to get screwed by the GMC if they get it wrong. You aren’t a better Dr by dint of doing 9 sessions a week as apposed to 2 , you don’t have a bigger brain. If you are breaking your back doing endless management work producing statistics for politicians , wake up! You didn’t get trained at medical school to be an expert in management, your value as a Dr does not reside in your management skills, there are heaps and heaps of professional managers who could do that work better and cheaper than you. people value Drs because they do medicine not because they do accounts. And as for Jeremy Hunt? He has done more to damage general practice in the UK over the last 15 years than literally anyone I could imagine . He was an absolute disaster for general practice as health minister. I suspect his current approach is fuelled by guilt as much as anything. People Locum and work part time as a means to stay alive, the job is toxic ..they aren’t bad Drs , they just have the guts and self respect not to be used
Continuity, dear boy, the committee is concerned about continuity, that is the point at issue
It is a simple mathematical fact, remember those ?, if the GP does more sessions, it is more likely the patient will be able to get in to see him again.
Now A cold bath and early to bed.
So, stop “micromanaging GPs” with targets and instead introduce a new target !! Are they dumb??