Across England, the story appears the same: general practice and wider primary care services are facing increasingly unsustainable pressures and NHS staff in primary care want and need to transform the way primary care services provides care to reflect this.
The challenge is how to enable primary care to play an even stronger role at the heart of a more integrated out-of-hospital service, delivering better health outcomes, more personalised care and excellent patient experience, in a sustainable way and as efficiently as possible.
The elephant in the room is that we need to deliver all this seven days a week. Arguably, the current model of primary care is no longer fit for a modern NHS. We know increasing numbers of patients are presenting in general practice with multiple long-term conditions, working days are longer and retirement is getting later. Many of the population (myself included) never get the time to attend their GP surgery. At one event, the chief executive of a local hospital told how a consultant had to cancel his entire clinic so that he could see his own GP.
If general practice is serious about offering health promotion and early intervention, then we need to be available to do this for people at a time that suits them.
More practice networks
So how can this be done when we are already facing a workforce crisis, when our own working day is too long and GP morale feels to be at an all-time low? How can capacity, that already feels so stretched, now be extended over seven days?
A recurring theme amongst GPs I’ve spoken to was that patients don’t need ‘more of the same’. Many described how they already have upwards of 40-50 consultations a day, seeing ever more complex problems, but with no slack in the system to give a corresponding increase in appointment length.
I work one day a week in a small practice of 5,200 patients, alongside three other part-time partners. We can’t offer a service 8am-8pm, seven days a week, on our own, but if linked with other practices who use the same IT system to create a practice network, we could.
In the past, we have worked as a small GP cooperative, where a relationship existed between practices and we could ensure an effective ‘handover’ of care for our most vulnerable, sick and dying patients. We told patients who they would see if they deteriorated, and we could share information with the attached community team.
That was more than 10 years ago. Now, with the highly systematic use of IT in primary care we should be in a better position to provide coordination of care across the seven-day week.
The challenges facing rural communities are far different to those facing inner city general practices, and resource issues will differ. However, I believe that this challenge offers us an opportunity to stop and reflect on our current way of practice. We should not see this as an 40% in our workload, but a chance to re-distribute our working week, and to ask how we can do things differently and more effectively as a consequence.
We should create opportunities to meet with community health and social care colleagues to develop the team approach. Continuity of care should be measured in terms of how care is delivered by a well-informed multi-disciplinary team.
There will be advantages for the profession. As presentations in surgery become ever more complex, is it appropriate still to offer a 10-minute appointment with the option of an occasional ‘double’? Do we get professional satisfaction trying to manage a patient with three or four long-term co-morbidities within such restraints? Creating space for consultations across a seven-day period could be an opportunity to offer patients a range of appointment times, using skill mix and spreading the workload differently.
For many GP colleagues, juggling a career with a young family, working at weekends may provide much needed flexibility. And am I alone in finding it increasingly hard to know my colleagues across the GP community? In the days of the GP cooperatives, there seemed to be far more coming together, opportunities for discussion about patient care, about general practice and about life.
Working across seven days will give many practices opportunities to work together in a different way, reduce professional isolation and increase opportunities to collaborate, so that general practice truly will be able to play an even stronger role at the heart of a more integrated out-of-hospital service.
Dr David Geddes is the head of primary care commissioning at NHS England, and a GP in York.