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Improved Access or Continuity of Care?
Pulse recently highlighted whether or not greater access works against the quality of care. The Department of Health claims that it is promoting both in the new GP contract, with the requirement for a 'named GP' for older people and the pilot announced a couple of months ago looking at 8 till 8, seven days a week service for 'working people'.
What is a named GP?
The Department of Health said that having a named GP will bring back ‘old-fashioned family doctors’, with patients given a ‘dedicated GP personally accountable for their care around the clock’. The Health Secretary has said that the move is intended to drive forward better-integrated, coordinated, out-of-hospital care and ensure “patients and relatives have a single point of information and responsibility for their care”. Under the changes to the NHS contract, GPs are to ensure the four million patients aged 75 or over will get all the treatment they need for physical and mental conditions, but there is significant confusion around what exactly this means in practice.
GPs are to oversee personalised care plans integrating all services, so that the elderly are better cared for in the community, reducing hospital admissions. Getting rid of the rigid, one-size-fits-all approach is aimed to improve patient care and doctors will be trusted to use their professional judgement and make decisions based on what each individual patient needs, taking all their medical conditions into account. Having named GPs for the over 75s is just the first step in the plan to improve continuity of care, but there is also the possibility of rolling it out to other groups in the future, including patients suffering from long-term conditions. The Department of Health has said ‘it is hoped’ that this service will eventually be offered to millions more vulnerable people with long-term conditions that need more support.
How will services be provided for those with busy lifestyles?
Whilst trying to focus on personalised care for the elderly, in contrast, the Department of Health is pushing for over 1,000 GP practices to trial 24-hour telephone access and weekend surgeries as part of a major move towards radically extending GP opening hours, designed to support ‘forward-thinking services to suit busy lifestyles’.
In some areas GPs will also be offering extra services such as Skype consultations as well as services in additional venues, establishing new urgent care centres with extended opening hours and a GP-led case management service across primary, community and secondary care.
The Prime Minister himself stated: “Back in October, I said I wanted to make it easier for people to get appointments that fit in around a busy working week and family commitments”. So how does the Government expect GP’s to achieve all of this and effectively provide good patient care?
Increased availability must not compromise clinical need
However, the General Practitioners Council (GPC) has warned that a ‘long-term plan’ is needed to support all GP practices. GPC Chair Dr Chaand Nagpaul recently said: “These pilots will give some GPs the opportunity and resources to test ways of improving access, use of technology and extend their opening times in areas where it is felt there is demand from local patients. However, as pilots, it is important that these are independently evaluated to ensure they are a responsible use of stretched NHS funds. We must ensure that practices have the flexibility to tailor their opening times appropriately for their local population, and this must not be at the expense of their availability to those most vulnerable patients in greatest need.”
How will demand be met?
GP Practices are already facing heavy demand. It’s not uncommon for patients to have to wait two weeks for a routine appointment, and some patients struggle to get an appointment at all. Data from the GP patient survey in England shows one in 10 could not last time they tried.
The Patient Association’s Chief Executive, Katherine Murphy, said: "We hear daily from patients that they can't get appointments. It's even worse for those who want a named doctor for continuity of care. They have to wait two or three weeks. It is becoming a real issue. "We need more investment in general practice, but I think we also need greater flexibility from doctors - it can no longer be a nine to five service."
However, it is believed that more than seven million patients across the country will benefit from innovative pilot schemes trialling improvements to GP access, funded by the £50m Prime Minister’s Challenge Fund.
Although there is genuine concern about how quality patient care can be delivered whilst opening for longer and stretching already limited resources, the message is to stay positive. NHS Central Manchester CCG clinical director Dr Ivan Benett said that managing more care outside hospital was the only way to sustain the NHS and that extending practice hours was part of this.
Asked what he would advise other GPs regarding seven-day working, Dr Benett said: “To be positive about it, I think we can do this. In fact we have to do it because otherwise NHS is not sustainable, so we have to manage that urgent care activity particularly out of hospital and in primary and community care. I think we can do it. We are just one of a few pilot sites that are trying out different ways of doing it and time will tell whether that works. But be positive because actually the alternative is very much more scary than anything else.”
The Challenge Fund http://www.england.nhs.uk/2014/04/14/challenge-fund/