Our GPs are consulting more frequently than ever, but our patients’ health is deteriorating – NHS England needs to rethink its strategy for general medical examination and treatment activities Katie Musgrave
The crisis facing general practice is entirely predictable and will get worse. The question is what has NHS England been doing? Does its strategy work?
Its current plan is based on Fuller Stocktake and largely appears to accept the growing demand for appointments. It focuses on increasing the use of multidisciplinary teams and expanding the scale of services, including plans to separate urgent care from routine care.
There is a rough logic to this approach. After all, repeated pledges to increase GP numbers have proven unachievable (confusingly, our pesky GPs continue to retire or reduce their sessions clinical). So if demand continues to increase without finding more GPs, surely others will have to take our place?
One suspects that the effort to scale up common operations is designed in part to counter the risk of widespread operational collapse. It is better to consolidate medical facilities than to see them hand over contracts without anyone willing to accept the patients on their roster. It could also (for the skeptics) provide a route back to an out-of-hours GP contract.
But could scaling up or providing urgent care to a larger population have unintended consequences? Are there any problems arising from undermining the experience and continuity of smaller groups of GPs and nurses? Are staff in larger multidisciplinary teams adequately trained to manage undifferentiated presentations? Will patients who don’t have a regular doctor come back more often, see a different one each time, hear different opinions, and lose faith in their health care advice? Will clinicians take the easy route when dealing with more complex patients and make more tests or referrals instead of wrestling with the basics or building rapport?
Importantly, are patients less satisfied with larger clinics? Why is that so, if bigger is better? Are GPs more or less content to operate according to these models? Will they maintain the same number of clinical sessions or will they increasingly look for other roles after finding the workload too stressful?
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To date, NHS England has – surprisingly – focused minimal attention on developing parallel services. Children’s centers that are now closed and accessible to health visitors will provide vital support to new parents. With the growing need for menopause counseling, there is a clear opportunity to establish women’s health clinics. Or mental health cafes, where therapists are directly accessible for support. Despite the need for rapid expansion, the provision of these services remains, as always, in the hands of GPs. After all, who can provide cheaper menopause services than us? A more effective mental health service? But we can’t do it all (and we’ll die trying).
Rather than easing pressure, NHS England’s vision for general practice involves sending more work our way, increasing the demand for ever-increasing appointments. Do patients really need consultations twice as often as they did a few decades ago? (And it’s not the aging population that’s causing this; patients over 75 are the only group of adults who are seeing fewer doctors now than before Covid.)
Furthermore, outcomes have not improved, with life expectancy falling, hospital and ambulance services failing, and deaths at home increasing. So, despite consulting more frequently than ever, our patients’ health is deteriorating, GPs are leaving in droves and hospitals are being overrun. Someone needs to rethink the strategy.
In their wisdom, our leaders at NHS England have failed to recognize that GPs (and our surgeries) are a valuable resource, whose expertise must be protected. guard. Instead of encouraging patients to seek appropriate support through alternative services (or encouraging better self-care), they have continued to focus all and sundry in our direction. . Instead of recognizing that in-depth and ongoing clinical knowledge is indispensable in general practice, they prioritized scaling up services and quickly bringing staff to the frontline.
However, when the main problem is growing demand with insufficient capacity, NHS England cannot accidentally send more work our way. We simply must be allowed to focus on the services that only general surgeons can provide. Our leaders can drive transformation, but if their strategy is poor the results will be disappointing. With the NHS in a precarious state, even a small misstep could spell disaster.
If NHS England scraps enough GPs, while also dismantling our most effective practices, who will pick up the pieces?
Dr Katie Musgrave is a GP practice in Devon and quality innovation fellow for South West