Researchers have called for more evidence to be gathered about the clinical and financial impacts of new large-scale general practice models being pursued by NHS England.
A systematic review of data, published in the BJGP, concluded that ‘good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce’, with concerns raised about the future of care continuity.
The paper, authored by primary care researchers at the London School of Hygiene and Tropical Medicine, argued that ‘as more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why’.
The researchers found that ‘quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management’.
However they warned that ‘unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care’.
The Nuffield Trust also voiced concern about the potential loss of care continuity stemming from an ongoing ‘segmentation’ of general practice, including the move to larger practices and extended-access hubs.
In a report published earlier this month, the health think-tank said that the ‘rapid growth’ of policies favouring quick, transactional, ‘see and treat’ GP encounters ‘is pulling GPs away from the expert “medical generalist” role of general practice that is a defining characteristic of list-based primary care’.
The Nuffield Trust suggested that individual GP practices should ‘develop systems to spot complex patients for whom continuity of care may improve outcomes and encourage them to stick with a single doctor or clinical team’.
Meanwhile, large-scale practices should ‘monitor patterns of use of extended-access services to identify patients who could benefit from continuity and steer them towards their usual GP or GP practice’.
It suggested CCGs should ‘commission access hubs that are fully integrated with patients’ usual GP clinics’ as ‘most are currently linked through shared access to medical records and few deliver extended access that can offer continuity with a patient’s usual clinician’.
It added that NHS England should ‘invest in a research programme to identify which patient groups and clinical conditions can effectively be treated in transactional, rapid access services and which achieve better outcomes with greater continuity’, whilst also looking at the costs associated with the new care models.
The report said: ‘At a time when staff and money are in short supply, it is essential to clarify what we want from general practice and the role we want it to play in the wider NHS.
‘There are opportunity costs associated with the current emphasis on timely and convenient access because fewer resources are left to deliver medical generalist and multi-disciplinary care.’
It comes as a recent study also questioned policies, having found that patients who are less satisfied with their GP opening hours are no more likely to attend A&E departments.