General practice is facing a serious crisis. A lack of investment, increased demand and poor staff retention have put the profession under unprecedented pressure.
Earlier this year, the British Social Attitudes survey revealed that public satisfaction with GP services was at its lowest level since records began.
But while delegates at the Primary Care Conference could agree that times are tough, there was also a note of optimism as medical experts discussed how to turn a crisis into an opportunity.
Could these turbulent times be the catalyst for much-needed disruption and innovation?
The General Practice Forward View, a five year transformation scheme now in its second year, aims to provide both the funding and framework for an overhaul of how GP surgeries operate. Included in the strategy is an additional £2.4 billion of funding a year by 2021 designed to “accelerate transformation of services”.
“The GP forward view was the first time that the NHS and the government had admitted that they got the balance of funding wrong,” said Dr Richard Vautrey, chair of the British Medical Association’s General Practitioners Committee.
“Those of us who work in general practice know that funding has been falling year after year and is now at a record low. At the same time our workload is growing because of increased demand.”
There have been no shortage of initiatives aimed at curing the woes of general practice. The GP Access Fund, vanguard programmes and Primary Care Home have all offered potential alternative care models to handle the demands of an ageing population.
For Rick Stern, director of the Primary Care Foundation, each incremental improvement is a step in the right direction. He believes one way to ease the pressure of GPs is to build a wider primary care team including physiotherapists, pharmacists and other medical professionals.
“The world is kind of uncertain. We are trying to disrupt we are trying to innovate but it is not always easy on the ground,” he said.
“There are new models, new ways of thinking about general practice and how it relates to the rest of the system.
“I think there is a really exciting role for GPs as the medical consultants in primary care. This would allow for a better skills mix across primary care which would allow others to do a lot of the work that GPs are doing at the moment.
“Innovations in systems and process are more important than organisational design. For me if a GP team that meets together, talks together, eats meals together and generally gets on well then that is the key to success.”
Delegates also heard how the existing challenges facing GPs can only be overcome by letting go of old assumptions and long-held methods of working.
“I’ve been through 12 reorganisations of the NHS. You have to embrace change because if you fight it, it will just run over you,” said Dr Raj Patel, deputy medical director of primary care at NHS England.
“If we are going to engineer the general practice of the future, what will it look like? The first issue we need to look at is self-care, we have not been good at letting go of our patients. When banks and supermarkets are getting us to do most of the work ourselves, we still have this attitude that ‘doctor knows best’ and we have a system that is very opaque.”
For Dr Vautrey, perhaps the biggest challenge for general practice is reasserting itself as the backbone on the National Health Service. Greater recognition, he argues, will not only help with recruitment and retention but will have a positive impact across the entire health and social care system.
“Too many doctors and medical students view general practice as a second class service. But it takes a great deal of skill and dedication to work in general practice,” he said.
“We need to remind doctors of that and remind policy makers as well because they are focusing on the wrong area. If you get the foundation right then the rest of the NHS will survive.”
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