GP patient lists should be pooled across PCNs as part of measures to address the GP workload crisis, former RCGP chair Professor Dame Clare Gerada has said.
She set out a series of recommendations that must now be ‘put into action’ to protect GPs, including a ‘new service model’ to prevent ‘piecemeal’ care of complex patients.
She said: ‘Now more than ever the management of complex patients (including, I would suggest, those in nursing homes, frail elderly, those with complex comorbidities, and those with serious mental illness) must be moved outside the remit of day-to-day care of the GP and instead cared for through intermediate multidisciplinary teams, bridging the gap between hospital, general practice, and home, each adding complementary skills providing enhanced care to patients.’
Professor Gerada added that the partnership model is ‘outdated and holds us back’, instead advocating for the pooling of patient lists across networks alongside digital triage to direct patients appropriately.
She said: ‘The pandemic has shown the value of GPs working together — within primary care networks (PCNs). Patients and staff have benefited from the greater flexibility size gives.
‘We should build on this and pool patient lists across PCNs; allowing for continuity provided through personal lists (adjusted in size to address numbers of clinical sessions GPs undertake).’
And the number of patients GPs routinely see per day and per week must be capped, she added.
She said: ‘The current situation is intolerable, unsustainable, unsafe, and leads to burn out, depression, and poorer quality care. We must look to split the GP’s working week into digital, face-to-face, continuity, and multidisciplinary contacts — each given the necessary time with appropriate limits.’
Meanwhile, primary care must stop being treated ‘as a “sink hole” absorbing unlimited work’ that hospital doctors ‘can’t or won’t do’, Professor Gerada said.
She added: ‘GPs now need to have a hard conversation: what are we not going to do? Without that realisation, without that acceptance, then we are without hope.’
Professor Gerada also said:
- Secondary care colleagues should also take up a generalist ‘approach’ to stop the ongoing management of patients from flowing ‘unrelentingly’ to primary care;
- GPs must have ‘parity of esteem and pay’ rather than being viewed as a ‘cheaper alternative to consultant care or fodder to fill service gaps’;
- The planned extension to GP training from three to four years must be implemented;
- All hospital doctors must undergo core training in general practice of at least six months and at minimum ST4 level.
Addressing renewed controversy over GP access, Professor Gerada said that GPs have ‘moved mountains’ to help their patients.
She added: ‘Rather than being lauded GPs have been reprimanded, unjustly, for not being ‘open’. This hurts. General practice is open.
‘Our doors are so widely open that you can drive a coach and horses through them.’
It comes as the BMA’s GP Committee has paused all meetings with NHS England until the disagreement around face-to-face appointments in practices is resolved, saying it has ‘no confidence’ in NHS England’s executive directors.
Last week, health secretary Matt Hancock met with GPC to discuss the fallout. According to Mr Hancock, they discussed ‘what more we can do to strengthen access to GPs’, while the BMA said Mr Hancock ‘recognised’ the ‘extreme pressures currently facing general practice’.
In April, Professor Gerada told Pulse that 22% more GPs are presenting to burnout service NHS Practitioner Health – where she is medical director – than before the Covid pandemic.