For the world of general practice, 2013 promises to be as busy as it will be decisive.
With the arrival of clinical commissioning groups, the new era of revalidation, and vital changes to the GP contract, family doctors will never stray far from the centre of the debate. Last year showed the most enterprising GPs can achieve extraordinary things. Whether spearheading the expansion of IV treatments at home in Wokingham or cutting diabetics hospital admissions in Cambridge, we saw doctors asserting themselves over the healthcare system like never before.
This year, GPs must show even more of this clinical entrepreneurship to serve patients and the community effectively.
So what are the big priorities?
Well, first, we have to do better on dementia and other long-term conditions. A third of the population have long-term conditions and they currently account for more than half of GP appointments and over two-thirds of all money spent on the NHS. Getting their care right, helping them self-manage effectively, reducing pain and distress, and allowing them to stay hospital-free for longer, is one of the defining challenges thrown up by an ageing population.
As much as the NHS has shown early progress in finding the efficiency savings identified by David Nicholson, we now need a Herculean effort to shift the system from ‘salvage and rescue’ to prevention and early intervention. Strong general practice is at the heart of this, nowhere more so than in dementia care, where GPs are vital in helping more people get the early treatment and support they need, and I’ll be expanding on that in the months ahead.
A second priority is reducing preventable deaths. We have to face up to the fact that our record on premature mortality, particularly for the five big killers (cancer, heart disease, stroke, respiratory and liver disease) is not good enough.
Cancer is a case in point: we see far too many patients presenting late in A&E. But whether it’s the 800,000 with undiagnosed diabetes, or the million with undiagnosed chronic kidney disease, and the similar numbers with COPD, we need to find the ‘missing millions’ steadily accumulating ‘silent’ damage due to delayed diagnosis.
The new system is fundamentally about change at grassroots, giving GPs more scope, through their leadership role in CCGs, to develop the right services for their patients, working in partnership with all parts of the health and care system across the spectrum of prevention, early diagnosis and treatment.
This, for me, is the key: if we can do it well, we can really drive improvements and finally make England what it should be: a global beacon for excellence in preventative medicine, and one of the best in Europe for mortality rates.
Separating the optimists from the pessimists
Here’s another question for 2013: shouldn’t the country that first invented the internet now be at the forefront of a digital revolution in healthcare? Are we in danger of providing a service out of step with the realities of how people live today?
Face-to-face appointments will always be the staple – not all patients are able to, or would want to use technology for their interactions with GPs themselves. But we are already seeing how things like routine online bookings, text-based appointment reminders or negative test results and even ‘virtual surgeries’ can not only help make primary care more relevant to changing lifestyles but can help free up time allowing GPs and practices to spend more time with patients.
Yes, we have to mindful of capacity – I want to support GPs not hinder them – but this is an area we do need to push much harder if we want our services to become more responsive and convenient for patients.
Finally, the most important issue of all: how to safeguard standards of care across the NHS and beyond.
Shocking scandals like Winterbourne View and mid-Staffs have left many people fearing the basic values of compassion, dignity and respect are draining away from the very organisations that should embody them. This year has to be the moment when the high performing majority says ‘enough is enough’.
Transparency is one antidote: innovations like the Friends and Family Test for hospitals, and the proposed Ofsted-style inspections will help identify outliers and support continuous improvement across the system.
The NHS Commissioning Board (NHS CB) will be responsible for overseeing and championing quality for their patients, both in its role as the direct commissioner of primary care and other services as well as its oversight of CCGs. As I set out in the Mandate I will hold the NHS CB to account to deliver these services and quality of care on behalf of patients and the taxpayer.
In short, a new year always separates out the optimists from the pessimists, and 2013 is no different. Many argue this will be the NHS’s most challenging year. But with GPs at the heart of policy and practice, I believe it will turn out being one of its best.
Jeremy Hunt MP is the secretary of state for health.