The RCGP has released its vision for the next ten years of general practice, which includes GPs commissioning 24/7 out-of-hours care, making greater use of social media to connect with patients and endorsing a possible change to the GP contract.
The 2022 GP – A Vision for General Practice in the future NHS, clarified the college’s position on the out-of-hours care debate, recommending GPs work together as federations to commission 24/7 services for patients with complex comorbidities.
It also set out the college’s argument for a 10% increase in funding for general practice while making calls for a change to the GP contract to promote integration.
The college had faced criticism from GPs for seemingly endorsing practitioners taking around-the-clock supervision for the 5% of most vulnerable patients. It had sought to clarify its position and this report represents its most detailed policy yet.
The report said: ‘The aspiration for the future health service is to deliver, through better planning, more responsive out-of-hours care to patients, especially those where continuity in and out of hours is vital (such as those at the end of their lives or those with complex medical problems).
‘This does not mean a requirement for GPs to provide direct patient-to-doctor access out of hours: it is about the need to reshape services to improve the oversight and management of transitions in care and coordination of care between the practice team and others, on a 24/7 basis, involving a range of professions (medical, nursing, pharmacy and social care). Working together across federations of practices will facilitate better out-of-hours responsiveness and the ability to develop different models that are able to address the needs of different populations of patients.’
The college also recommended that GPs should run virtual clinics, hold consultations over Skype and communicate with patients over social media in an effort to provide more flexible and remote types of consultation.
It said that GPs need to become skilled in holding remote consultations, as simply increasing the quantity of traditional face-to-face consultaitons will not be a cost-effective or sustainable strategy for meeting growing demand and increased complexity of care. The report pointed to younger people who use social media sites such as Facebook ubiquitously to prove that the traditional face-to-face consultation will no longer be accepted as the ‘default’ way of communicating with their GP.
The report said: ‘The GP of the future will need to be skilled in using a suite of new and ﬂexible tools for communicating with patients, including telephone, email and various online forms of consultation.’
‘This will include online group discussions, where appropriate, for example, patients with long-term conditions where peer-to-peer support and shared experience can be particularly valuable.’
It added: ‘Based on the current direction of progress, the 2022 patient will expect to access their GP or primary care nurse remotely, attend virtual clinics involving primary and specialist practitioners, and communicate with their healthcare team via text message or social media-type tool.’
GPs should work across a range of community-based providers and such integration could involve a change in the GP contract. It said one of its goals was to ‘support change in the GP contract models to promote joint working across community-based providers and review the current employment and remuneration issues that act as barriers.’
The 2022 document encouraged practices to work in large federations to share ‘back-office’ functions, which would facilitate improved access to services such as talking therapies and physiotherapy that could be shared across the federation.
It reitterated its calls for a major shift in spending into general practice to address the current imbalance in funding, which sees GPs providing 90% of NHS care for only 9% of the NHS budget, the college said.
This includes increasing the number of GPs by at least 10,000 across the UK, and investment in practice premises to allow more care to be provided in the community.
RCGP chairman Prof Clare Gerada, said: ‘The NHS is changing, general practice is changing, patients are living longer with long term and multiple conditions, and health inequalities are growing, so we must step up and meet the challenges ahead.
‘This vision outlines ways in which to provide easier access to a more flexible and integrated system of primary care that will benefit our patients immensely. It maps out a way for patients to receive the best possible care in and out of hours from the start to the end of their lives.
‘As GPs change, so must the role of patients and so it is important to promote healthy lifestyles, increase health literacy and encourage self-care as we move forward with limited resources and increasing demand for services.’
She added: ‘Most importantly, none of this vision will become reality if we do not receive fairer investment for general practice. If GPs, who do 90% of NHS work for 9% of the budget, are not properly funded then much of this new vision will not be achievable.
‘Innovation and reform are vital but must be underpinned by investment. The Government must recognise that general practice is the most cost effective way of providing care and act accordingly, by urgently reversing the real terms decline in the amount of money that general practice receives.’