The House of Commons Health and Social Care Committee has released a report outlining ‘The Future of General Practice’.
The report highlights that up to 90 percent of healthcare is delivered by primary care despite staffing being an ongoing issue, with more GPs needed to meet the current challenges and demands. It shares some of the key issues facing general practice, such as demoralised staff; recruitment and retention; high reliance on locum doctors and the resultant bidding wars for their services; and the decline of continuity of care.
It notes that although several changes have been made in recent years to support general practice in becoming more sustainable, such as the creation of primary care networks (PCNs), the report found that these changes – although welcome – “are not yet making a meaningful impact” and can lead to patients becoming confused over signposting, and ultimately contributing to clinician burnout.
Here, we will examine some of the solutions suggested in the report, with focus on the role and contribution of integrated care systems (ICSs).
As part of the efforts to make general practice more sustainable, the report comments that it is “encouraging to see some ICSs agreeing to try to reduce the amount of work that is inappropriately transferred from secondary care to primary care”. It adds that NHS England should take further steps to address this, with solutions including “introducing e-prescribing in hospitals and focusing on the primary-secondary care interface by encouraging ICSs to provide a reporting tool for GPs to report inappropriate workload transfer”.
To work towards solving the issues facing general practice, the report recommends a number of solutions including abolishing the Quality and Outcomes Framework (QOF) and Impact and Investment Framework (IIF), stating that they have “become tools of micromanagement and risk turning patients into numbers”.
Another recommendation is for the government to examine the possibility of limiting the list size of patients, using 2500 as an example with plans to slowly reduce that to around 1850 over five years as more GPs are recruited.
With regards to innovation and improvement, the report remarks that historically a key driver in this area has been the GP partnership model, which provides them with the flexibility to innovate in response to local population needs. Whilst acknowledging the significant pressures on GP partners at present, the report states: “the evidence we received was clear that the partnership remains an efficient and effective model for general practice is properly funded and supported. It is important that the model of general practice can vary according to local needs, so other models of delivery should also continue to be explored where this works for local communities.”
The report also highlights the need to simplify the patient interface, outlining how many patients are left unsure if they should call the out of hours service, their surgery, go to A&E or call 111, which adds more pressure onto general practice.
It states that PCNs and ICSs “offer an opportunity to better integrate care around people. It should not be the case that patients face so much uncertainty about where to turn to if they have a new or urgent care need and it is particularly unacceptable if the number of different organisations involved in providing first-contact services to patients makes it harder to patients to access the care they need.”
Dr Claire Fuller’s primary care review is praised for making this a priority and emphasises that ICSs should “prioritise simplifying the patient interface with the NHS by improving access, triage and referral across first-contact NHS organisations including general practice.”
The report goes on to say that despite the potential of these new organisations, “current incentives in general practice and wider primary care are not aligned with the outcomes that matter to patients and do not encourage GPs to use their judgement to focus on what would most benefit their populations”.
On this note, Nottingham City Integrated Care Partnership’s Clinical Director Dr Hugh Porter comments: “The move to ICSs, with this system working and population health management, is actually welcomed by most places involved and by general practice. General practice has been in a holistic, [population health management] sort of world throughout, and that is the way it has always operated, so the system is moving closer to how general practice thinks.”
Moving on to examine health inequalities, the report notes how the challenges of general practice are different depending on the part of the country, with some areas facing challenges such as workforce shortages being more acute. It comments that “these are often areas where there are already higher levels of ill-health and deprivation” and calls on the government and the NHS to “develop a better mechanism to award funding to more deprived areas to replace the Carr-Hill formula which is insufficiently weighted for deprivation at present”.
Another factor raised by the report is that GP organisations “need more headspace and organisational support” to change the way they work and make new organisations work effectively. The report states: “At its simplest headspace can mean time for GPs to design new systems and processes, but it has also been used to refer to organisational development support such as data and analytics or business management capacity.”
On this topic, the report points out how Dr Claire Fuller’s report specifically identified several areas in which “ICSs require further support in order to integrate primary care effectively”, with particular support needed from NHS England and the government around estates, workforce and data.
Dr Fuller said: “There is real commitment, but there is still an understanding that there are some things we need to put right, which is around the workforce, around the estates and around the data. We need to put those in place, and ICSs need to create the right environment and to focus on delivering care in this team-based way rather than in the siloed way.”
Finally, the report emphasises the need to make general practice “not just manageable but once again fulfilling and enjoyable”. It states that general practice needs to have “its professional status restored with a decisive move away from micromanagement and short staffing to a win-win environment in which investment in general practice reduces pressure on hospitals and saves resources for the NHS.”
On our sister site, HTN, we interviewed Dr Claire Fuller earlier this year; click here to read what she had to say.
Similarly, click here to read the House of Common’s report in full.