The BMA has proposed that networks of practices work together to offer extended access and more alternatives to face-to-face consultations, in its vision for the future of general practice published today.
The major policy paper calls for a radical shift in the resourcing of general practice, and backs the ‘named clinician’ idea promoted by the health secretary for all patients with long-term and complex needs.
It also calls for an extension of GP training to five years and a 10-year rolling programme to ensure all GP practices that require it have a ‘purpose-built surgery’.
The Developing General Practice: Providing Healthcare Solutions for the Future policy paper details the BMA’s argument for greater resources to be given to GPs in order to ease the ‘severe pressure’ practices find themselves under and gives a list of suggestions on the way forward.
It suggests that the arrangements under the extended access DES should become more flexible, so that networks of practices can work together to offer surgeries at different times.
The document says that ‘collaborating with other practices to provide extended hours surgeries at a range of different times across a community’ would enable this to happen.
It also suggests that GPs should offer ‘more alternatives to a face-to-face consultation when clinically appropriate, such as dedicated telephone and/or Skype surgeries’.
It comes after NHS England included extending GP access in its ‘call to action’ consultation on primary care and after the Government announced it would trial groups of practices opening from 8am to 8pm on weekdays and also opening at weekends.
The document also says that all patients with long-term and complex needs should be ‘jointly managed through an integrated team in line with a single care plan led by the most appropriate named clinician’. This echoes the plans set out by health secretary Jeremy Hunt, which will see individual clinicians – most likely GPs – overseeing the whole care provided to vulnerable elderly patient.
Pulse revealed last week that the GPC is set to agree to the named clinician plans in exchange for a removal of the bureaucratic elements of the QOF. The document sets out the GPC’s support for such plans, despite the opposition of many in the GP profession.
The BMA document states: ‘Patients with long-term and complex needs should be jointly managed through an integrated team in line with a single care plan led by the most appropriate named clinician. This would require a much greater alignment of incentives and funding streams between general practices and hospital and community service providers.’
To improve the recruitment and retention of GPs, it suggest ‘lengthening GP training to a fully-funded ﬁve years with a much greater proportion of time training based in general practice’.
The GPC urges improvements to urgent and out-of-hours primary care services, including a clinician-led first point of contact and the removal of the ‘compulsion’ for competitive tendering for out-of-hours care.
There should be greater sharing of GP records across the NHS, long-term incentives to expand GP partnerships and initiatives to support GP returners back to work in order to solve the current shortage of GPs.
GPC chair Dr Chaand Nagpaul said: ‘Our vision for general practice is a bold plan to address both the immediate pressures facing GPs and develop a long term strategy for patient care by improving coordination, integration and quality.’
‘We need to look at new ways of working that can help GPs play a central role in delivering care that is more efficient and responsive to the needs of patients who increasingly need services that are more personalised and closer to home.’
‘To make these ideas a reality general practice needs greater investment to enable an expansion of the GP workforce and to fund new and innovative ways of working. We must end the uncertainty about future funding which is holding back GPs from meeting short term challenges and setting long term goals that could be a solution to alleviate some of the pressure on the NHS as a whole.’
But Dr Peter Swinyard, chair of the Family Doctor Association, said that the extended access proposals would not prove popular among many GPs.
He said: ‘I know that the change will not be welcomed by many of my colleagues, and I think some people will say it’s a sell out and that it’s the Government agenda just being parroted by the BMA.
‘[But] things have become so tight in general practice at the moment that, especially smaller practices, are just not going to survive without working together with other people. It just isn’t viable anymore, and we have to start thinking differently about how we’re going to organise ourselves.’
Dr Grant Ingrams, a GP in Coventry, said that the extended access plans would harm the core role of general practice to provide continuity of care.
He said: ‘The evidence from this country, from studies elsewhere, is that what gives you the best healthcare is seeing a doctor you know. And you cannot do that, if I’m in a rota twenty other doctors, or sixty other doctors or whatever, you lose that.’
This article was altered on 07/11/13 at 22:22 to remove the suggestion that the BMA backed the health secretary’s call to extend GP hours.