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RCGP criticise report saying GPs' role should be downgraded

GPs have accused a report, which suggests their clinical role should be downgraded to make the health system more efficient, of being full of impractical ideas.

The report, ‘Who Cares? The Future of General Practice’, from right-wing think tank Reform, says that the system of referring most healthcare problems to GPs in the first place is leading to inefficient spending and fragmented support for patients with chronic health conditions, and that the government should abandon its target to employ 5,000 more GPs.

However, the Royal College of General Practitioners (RCGP), have said that the suggestions are impractical and that more GPs are needed to relieve existing pressures on the system.

Alexander Hitchcock, one of the authors of the report, said: “We need a whole new model of care in general practice.”

The report recommends a ‘population health’ approach, where large-scale providers address all the health needs of a population, including encouraging lifestyle changes to prevent chronic conditions developing, and more triaged care, with simple queries potentially being dealt with over the phone or by Skype or by a nurse.

Barry Cooper, chief operating officer at Vocare Group, wrote for the latest edition of NHE about the benefits of GP consultations via videoconferencing.

The report also points to schemes developing AI technology to provide healthcare, such as algorithms to diagnose diabetic retinopathy currently being developed by the California Health Care Foundation, as potential models for new large-scale UK healthcare providers.

Dr Maureen Baker, chair of the RCGP, said retaining the 5,000 GP recruitment target was necessary to reduce some of the pressures on GPs, with almost 90% of GPs struggling to find staffing cover and almost 300 GP surgeries reporting serious financial problems.

Dr Baker said: “Many of the recommendations in today’s report cannot be done in most practices with the time and resources available. Relying more on practice nurses, for example, is impossible when many surgeries are struggling to recruit – and existing practice nurses aren’t simply sitting around waiting for patients to walk through the door, they are under just as much pressure as GPs.

“GP practices are already offering different types of appointments, such as phone consultations. But despite our efforts, demand is rising so acutely that this is having little effect in terms our workload.

“The College does recognise that there is huge potential in using technology to support patients and the health professionals who provide their care – but moving ideas from the drawing board to reality will be unachievable without investment in general practice.

“Finally, we are concerned about the call in this report for greater choice and competition in the NHS – something that has certainly not served our patients well over the last ten years and through the recent health and social care reforms.”



Michael Wray, Inhealthcare   18/04/2016 at 21:28

While the bundles of paper records dragged along hospital wards each day blatantly demonstrate the technology problems that exist in secondary care, the same charge cannot be levied at primary care. GP systems operate slickly for all those things primary care practices do every day. They enable rapid appointment booking, prescribing and they allow a GP to get through his or her mountain of 50 patients a day. Some might describe them as glorified CRM systems, but they are built that way for a reason. The technology is purely an enabler for the business model of primary care, and the business model is driven by the way services are commissioned. As services start to be commissioned in more sensible ways (around the patient rather than around conditions), we should start to see new models of care delivery. These will involve diverse teams which will only be able to succeed if they can work in a coordinated way. This means process, workflow, compliance and audit; it means the management and orchestration of the teams so people know what they are doing and are able to measure how well they are doing it. These will only work if the patient is at the centre, and therefore has a significant role in the team. Technology must be the enabler for these new models, delivering appropriate communication and information flows. The statistics in the report perhaps suggest patients don;t use online services, but this is down to the fact that the GP online services don't offer anything new. Why would a patient go to the trouble of booting up their computer and logging on to book an appointment when they could just pick up the telephone? It's only those who've worked out they can jump the queues by logging on at 8:30am who ever use it. This is not using technology as an enabler; it is not digital health. Digital health is about enabling new care models, using technologies that help with process, workflow, compliance and audit, using the communication channels most appropriate, be it online, mobile apps, SMS, phone or connected device. It will help include the patient in their own care, it will automate the mundane and it will allow us to measure the effectiveness it terms of health outcomes and delivery cost. Only then can we tackle the long terms conditions, not only in patients, but in primary care too.

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