Health Service Focus

Best Practice Show 2014

Sam McCaffrey reports from a major event in the primary care calendar.

It is safe to say that at the 2014 Best Practice Show all eyes were on the future. Not only were the speakers and attendees focused on the challenges facing general practice over the next few years, but it also happened to be the day that Simon Stevens and NHS England released the Five Year Forward View, detailing how the NHS must transform over the next five years to meet the demands of an ageing population.

The report cast a shadow over the event with every session looking slightly different in the wake of it. The most obvious change was the cancellation of Andy Burnham’s keynote address in the morning, the shadow health secretary remaining in Whitehall for a debate on the report. In his place he dispatched Lord Philip Hunt who faced a tough crowd and was heckled when he refused to answer a yes or no question about whether Labour would scrap its policy of ‘GP access within 48 hours of trying to make an appointment’ if leading doctors told them it wouldn’t help care.

In a debate on whether general practice needs 10,000 more GPs, Maureen Baker, chair of the RCGP, continued to lead the charge calling for the increase. She pointed out that in the last 10 years the NHS has trained and recruited three times more hospital consultants than GPs. But while the extra GPs are needed, Baker said the health service is unlikely to see them before 2020.

She also welcomed the input of pharmacists in helping deal with the increase in demand on GP services: “I think there is a clear role that pharmacists working in and with general practice can provide.”

Ash Soni OBE, president of the Royal Pharmaceutical Society and clinical network lead for Lambeth CCG, picked up on that and pushed strongly for a larger role of pharmacists. He said that pharmacists working in general practice does happen at the moment but it is not utilised enough and if it were it could ease the pressure on primary care.

The high point of the morning on day two was a talk by Dr Nigel Watson, chief executive of Wessex LMCs (local medical committees), on ‘How to make the government’s agenda work for you’: a topic that felt especially relevant. He said that top of the political agenda at the moment is integrating care, which is “talked about an awful lot and delivered very badly”.

Dr Watson described a view of integrated care where GPs take the lead, empowered by CCGs, to create and run community-based teams working in an integrated way with general practice. His vision of integrated care includes a common health record that both the community teams and those in GP surgeries can contribute to, care plans being produced jointly and teams working in partnership rather than “having tiers upon tiers of management finding out ways of why we can’t do things together”.

He sees the future as having more services provided in the community. Diabetic consultants working in GP practices, community psychiatric nurses seeing patients with mental health problems in surgeries, and care navigators who follow up and monitor patient care between services. Dr Watson said such changes would make things “better for the patient, better for us [GPs], and better for the system”.

A common theme of day two was the problems posed by long-term conditions. Dr Watson described them as one of the biggest challenges facing practices, and Dr Minesh Patel, chair of Horsham and Mid Sussex CCG, said the Quality and Outcomes Framework’s (QOF) biggest weakness is the long-term illnesses it doesn’t cover.

Dr Patel was talking about what quality care looks like in a post-QOF era and posed questions about outcomes. “Whose outcome is it that we need to measure? Is it the systems outcome, is it our outcomes as organisations, as professionals – or actually is it the patients’ outcome and what matters to them? Is it the same thing? I think clearly the answer is it probably isn’t.

“Whatever we think of our relationship with patients, the future will be about paying for outcomes that our patients and our populations value, and they won’t always be the same things that we value.

“GPs and CCGs can no longer ignore the patient in the conversation about outcomes.”

Dr Patel closed on an optimistic note, pointing out that GPs now have a great opportunity to help shape the system that they work in.

“CCGs as they are now create windows of opportunity. They are membership organisations and there is a window here to engage with them, as members, to create the sort of system that we want to create, and I’m not sure that the window will be there forever because the system will need solutions to fall into place.”

He added: “The key here is to engage with your CCG as members and to actually design. The future isn’t being dreamt up somewhere else, it’s going to be dreamt up by the membership.”

Coverage of Jeremy Hunt’s speech at the show can be found here.

Tell us what you think – have your say below or email [email protected]