RCGP: New approach needed to tackle ‘fragmented’ multimorbidity care

GP practices are not currently set up to deal with patients living with multiple long-term condition, a new report from the Royal College of General Practitioners (RCGP) said.

The RCGP estimated that by 2025, the number of people living with multimorbidity in the UK is expected to go up from 8.2 million to 9.1 million, costing an additional £1.2bn for health and social care.

However, the report said GPs were being held back from treating patients with multimorbidity by current care structures. The average appointment is just over nine minutes long and includes discussion of two different issues, but this is insufficient to address everything, especially as some patients have over five conditions.

Professor Maureen Baker, chair of the RCGP, said: “Currently, care is mostly channelled towards single disease conditions, resulting in a vast number of our patients receiving fragmented care. We need to tailor the services the NHS provides to better suit our patients’ changing needs.”

She added that it is important collaboration is supported to enable better communication between the primary and secondary care sectors by adopting improved IT systems.

“We must also review performance related payments that relate to disease specific targets with the aim of developing alternatives, and we need to conduct more research into understanding the experiences and outcomes of those living with multiple long-term conditions to enable us to provide the best possible care for these patients,” she said.

At the moment, guidelines advise GPs on medicines to prescribe in order to treat a particular condition – not how to treat the patient in the context of all their conditions. But patients with multimorbidity are more likely to be prescribed more drugs, with 42% of patients with six or more conditions being prescribed 10 or more medications.

This increases the risk of human error or adverse reactions to medication, which account for 6.5% of all hospitalisations. Prescribing drugs also costs the NHS more than £10bn a year.

The RCGP report also criticised the quality and outcomes framework (QOF), which the college has previously said should be replaced with new funding arrangements.

It argued that the QOF, which links financial incentives to the quality of treatment of key conditions, “makes no attempts to review, and reward, how well practices treat patients with multiple long-term conditions”. The Royal College stated that incentives should focus on factors such as relationship quality, self-management and consistency, instead of disease outcomes.

The report added that GPs should prioritise longer consultations for those with multimorbidity, and monitor which doctors patients see to ensure that they were able to maintain ongoing relationships with practitioners.

It also said multidisciplinary teams around general practice were needed to ensure that GPs could gain rapid access to other care providers who could help patients with multimorbidity, such as district nurses and mental health and social care services.

Furthermore, it called for better lines of communication between primary and secondary services, such as the use of in-reach teams and advice lines.

Other recommendations included improving the interoperability of IT systems to facilitate collaboration between the health and care sectors, developing face-to-face dedicated medicine reviews for all patients with multimorbidity, and funding new research into multimorbidity.

The report also said that funding should be channelled towards areas with the greatest multimorbidity needs, which are more likely to be economically deprived, not just areas with the greatest overall population.

NHS England has promised £2.4bn of funding to help GP practices cope with growing demand in the GP Forward View.

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