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GP ‘cottage industry’ not fit for purpose, says King’s Fund

The small business model of general practice is ‘not fit for purpose' and should be replaced with larger, more federated practices, concludes a report from an influential think tank.

The King's Fund report suggests practices delegate more work to nurses, commit to using more technology in their practices and set themselves up in more accessible locations, such as supermarkets.

The report – Transforming the delivery of health and social care – presents the ‘case for change' in the NHS and says that commissioners should stop focusing on ‘quick fixes' and embrace wholesale reform of services to make them more integrated and more like other service industries.

Published this month, it singles out variation between GP practices for particular criticism, saying the ‘cottage industry' model is not serving patients' needs.

The criticism comes after a major investigation by the King's Fund into general practice last year urged the Government to encourage commissioners to drive up quality in general practice – using tools such as balanced scorecards and local audits.

The report, authored by King's Fund chief executive Professor Chris Ham, director of policy Dr Anna Dixon and adviser to the chief executive Beatrice Brook, also recommended the shift in services from hospitals to the community would require the adoption of new ways of working, including better use of email and telephone consultations and training more GPs.

The report concluded: 'In many parts of the NHS, general practice still resembles a cottage industry in which family doctors as independent contractors run small businesses that are isolated from each other and constrained in the range of services they are able to provide,' the report said.

'Primary care in the United Kingdom is more firmly established than in many other countries and provides a wider range of care than at any time in the evolution of the NHS.

‘Despite this, there is evidence of wide variations in the quality of care and inequities in the distribution of GPs. If the aim is to tackle these variations and to deliver more care out of hospital, the current cottage industry model of general practice is not fit for purpose,' it added.

The authors recommended more practices should be opened in locations convenient for patients, such as supermarkets, following on from Sainsbury's attempt to open surgeries in its stores.

‘Across the public sector there are opportunities to better organise the community estate and to create one-stop facilities for housing, benefits, health care and other services.

‘Innovative practices are showing the way by delegating more tasks to nurses and other staff, enabling GPs to focus on diagnosis and urgent needs, and to lead the work of the primary care team.

'Larger practices are also able to make use of the specialist expertise of some GPs, thereby reducing the use of hospital services where clinically appropriate.'


King's Fund recommendations for general practice

·         Need for larger practices offering more services

·         Better use of technology such as email and telephone consultations

·         Encourage more self-care

·         More GPs need to be trained to avoid a shortage

·         Adopt more innovative practices e.g. greater use of nurses

·         Deliver care in more convenient settings e.g. supermarkets

Source: King's Fund


Story updated: 10.36 07/09/12