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A chance for a rethink on what matters

As the King's Fund inquiry into general practice looks set to recommend a focus on continuity of care and the doctor-patient relationship, is it finally time to give patients what they really want?

You wouldn't have guessed it from last week's televised leaders' debate, but a major row has broken out over the future of the NHS. It centres on the Government's £20bn programme of efficiencies, and whether they can be delivered without severe cuts to frontline care. Unfortunately, at least for those who would like a measure of democratic choice, all three main parties are broadly in agreement, clinging to the belief that swingeing savings can be implemented without any serious impact on the front line. The key arguments are raging not between politicians, but among leading doctors and health economists.

Professor John Appleby, chief economist at the King's Fund, is one of those warning of serious damage to the front line. He says PCTs will be left to choose between ‘high-value and low-value' care, and are likely to get the key calls wrong, because the NHS is terrible at knowing what constitutes value. There is already evidence of just those kinds of false value judgments, in the decisions by PCTs across the country to systematically begin closing smaller practices.

So how could NHS managers convince themselves it was necessary, for the sake of efficiencies, to set a minimum list size of 5,500 patients, to coalesce practices into polyclinics and to begin shuttling patients across PCTs in battlebuses rather than allow them access to GPs near their homes? How could PCTs have so undervalued the personal, long-term care offered by so many small practices? The answer, as Pulse reveals this week, is actually simple enough. Managers have got it wrong because the tools they have been given by the Government to measure quality – primarily the patient survey and balanced scorecards – are fundamentally flawed.

The King's Fund inquiry into general practice, which was greeted with suspicion by some GPs when first announced, actually looks like providing a huge fillip to general practice, by offering an assessment of quality as the profession itself sees it. Continuity, long-term planned care, the therapeutic relationship – these are the new quality metrics the inquiry team will recommend. And its leaders, including the pre-eminent GP academic Professor Martin Roland, are scathing of the Government's obsession with crude numerical measures, and with extended hours, quick access and workplace convenience. They are set to deliver a damning deconstruction of everything the outgoing Government has based its health policy upon.

The question now is the likely impact of the inquiry's recommendations on the next government's primary care policy. Up until now, there has been a cosy consensus between the parties on choice, access and convenience. Will our new political leaders, whoever they may be, have the courage to challenge their preconceptions about what really matters in general practice?

Our report this week of a patient consultation on plans to reshape general practice might offer some encouragement. It found just a tiny fraction of patients valued extended hours or an open choice of practice, while far more wanted a GP they knew and the option to book appointments in advance. Surely it is finally time to give patients what they really want?

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