GPs are unable to co-ordinate care for people with long-term conditions due to their ‘intense workloads’ and ‘insufficient funding’, concludes a new report.
The report from a leading thinktank analyses five case-studies on the co-ordination of care, including the South Devon and Torbay community virtual wards, a Macmillan community palliative care service in Midhurst, a dementia service in Oxleas and a mental health project in Sandwell in England, as well as a community resource team project in Pembrokeshire in Wales.
The King’s Fund report – entitled Co-Ordinated Care for People with Complex Chronic Conditions – found that ‘limited engagement’ from GPs reduced the effectiveness of the care co-ordination schemes in place.
The report said: ‘Of concern to all programmes was the apparent disengagement of GPs, which sometimes made effective information exchange difficult and prevented them from bringing the GP’s general knowledge of the patient/family into discussions about their care.’
‘This lack of engagement from GPs represents a curious paradox, as one of their core roles is to provide continuity of care to local people and to act as the patient’s advocate through referrals to other services,’ the report added.
However the researchers acknowledged that there were several possible reasons behind this finding, including that the GPs did not have time to engage with programmes or were not funded in a way that enabled them to do so.
The report listed ‘a payment model that places the work of GPs outside the wider health and social care system’ and ‘the lack of time to get involved in care planning (for example), given intense workloads’. It also cited ‘a lack of sufficient remuneration for the work involved’ as a possible reason, but also ‘GP’s preference to work as independent practitioners’.
It comes after the Government has said that the health secretary’s ‘named clinician’ plans are based on current NHS funding.
Commenting on the study, King’s Fund assistant director of policy Richard Humphries said he hoped its findings would be considered by the integrated care pioneers due to be announced shortly by the Government.
He said: ‘The importance of co-ordinating care has risen rapidly up the policy agenda. Our comparison of these five local success stories – the first analysis of its kind – shows that it is rarely easy to build an effective system of joined-up care. Common challenges include the need to strengthen engagement with local GPs and build better links with secondary care, as well as difficulties in securing long-term funding.’
As reported by Pulse last month, 28 areas have been shortlisted to compete for eight slots to become integration pioneers and be ‘helped’ by a central Integrated Care and Support Exchange (ICASE) team which is being put in place. Monitor, which is one of the bodies involved in selecting the pioneers, said there will be between 15 and 19 pioneers.
Chronic Conditions: Clinical Challenges
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