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GPs ‘need incentives to provide continuity of care’

By Lilian Anekwe

GPs need guidance and incentives if they are to continue to provide good continuity of care in the face of major NHS upheaval, the leader of the King's fund inquiry into general practice has told Pulse.

Dr Nick Goodwin, project director in charge of the wide-ranging inquiry into the quality of general practice, urged the new Government to consider incentives for GPs who provide good continuity of care.

His comments came in the latest of the King's Fund reports into different aspects of general practice, which the think tank has promised will ‘capture the spirit' of the profession.

The paper on continuity of care recommends politicians ‘ensure better understanding of the important of continuity and the need to prioritise or incentivise it alongside other developments on health care.'

‘Despite professional recognition of the importance of continuity of care, there is little practical guidance for GPs on building and sustaining food relationships with patients, and neither relationship continuity nor management continuity are monitored or incentivised in the same way as other aspects of good practice such as access or prescribing.'

Dr Goodwin told Pulse: ‘Continuity of care certainly should be incentivised. The problem is that the things that matter most to patients are difficult to measure and so we have the potential of losing the value of it. We have focussed on access and clinical standards, but these things are artificial in some ways and as a result continuity of care has declined.

And he warned against the coalition Government's plans, exclusively revealed by Pulse, to scrap the patient survey and replace it with a network of local health watchdogs to monitor practice performance.

‘Asking patients their opinion is important because it's the only way to get a handle on these issues. But if you are going to do it locally you might be shooting yourself in the foot.

‘Andrew Lansley is very keen on immediate input and real time feedback and I think that's interesting, but it could be overload from a patient's point of view.'

The continuity of care paper was published at the same time as a review into the quality of GP diagnosis and referral, also conducted as part of the general practice inquiry, which identified variation in the quality of diagnosis and scope for improvement in referrals.

And as Pulse revealed in May, the report warns that balanced scorecards and other tools used to benchmark crude referral rates were unfair tools with which to judge GP performance.

‘While genuine inequity should not be accepted, a naïve pursuit of standardisation could be dangerous, and should not be encouraged… primary care trusts should be strongly discouraged from using overall referral rates as a performance management measure', the report found.

Dr Goodwin said: ‘Trying to improve quality in diagnosis and referral just by using balanced scorecards is not the right approach. It is legitimate to measure these things but when you get down to penalising individual practices or individual doctors the legitimacy wanes.'

And he backed GP consortia, which the White Paper says all GPs must operate in by April 2012, to improve the quality of referrals.

‘There's some evidence that smaller practices, or practices that are more isolated, have referral rates that are difficult to explain. So I'm quite in favour of federated models because they can enable practices more time and opportunity for training, continuing professional development and peer review, which ought to help.'

The quality of GP diagnosis and referral Continuity of care and the patient experience GPs 'need incentives to provide continuity of care'