Claire Stidston, one of PPL's experienced consultants is currently supporting primary care transformation across a collaboration of 8 CCGs in North West London.
Transforming the meaning of General Practice
The core mission of the NHS remains unchanged, but to ensure primary care services continue to deliver it, the role of general practice must evolve.
In setting out the vision for the future of the NHS, the Five Year Forward View states that ‘Our nation remains unwavering in the commitment to universal healthcare, irrespective of age, health, race, social status or ability to pay: high quality care for all’. These values haven’t changed since the NHS was founded in 1948, but the world we live in has.
People today are living for longer with more complex conditions and as a result demand on the healthcare system is increasing. As society develops and technology advances, our lifestyles, healthcare needs, and expectations of healthcare services change. In primary care specifically, the model of general practice that has served us well in the past needs evolve to ensure it can continue to deliver quality care for patients: GPs and the rest of the primary care workforce require better support to deliver care effectively and efficiently.
Consequently primary care transformation is taking place London-wide, focused on improving the quality of care for individuals, carers and families, empowering and supporting people to maintain independence and to lead full lives in their community. This transformation is being driven by the Strategic Commissioning Framework (currently draft for engagement) that has been co-produced by NHS England and a wide range of stakeholders across London to provide a vision of the service offer that the public can expect from General Practice.
The Strategic Commissioning Framework supports service improvement around the three aspects of care that matter most to patients: pro-activity, access and co-ordination. The aim; to enable patients to receive high quality, responsive, urgent and routine care in a location closer to home and at time that is more convenient for them.
While the Framework offers great potential to drive improvement, its success hinges on recognising the different needs of the people served. At a basic level the population of today consists of two main groups of people - those who are generally healthy and those who have complex conditions. These two groups have very different primary care needs. People who are generally healthy mainly require easy access to services out of work hours at locations that are convenient to them. Whereas people with complex conditions require longer appointments, potentially with a number of different healthcare professionals, but also require continuity of care co-ordinated by someone they know and trust.
As a result, the model of general practice of the past, by which all patients expect to see their own GP within normal working hours on a 10-minute appointment basis, is no longer appropriate for either of these groups. To achieve the transformation required new models of General Practice are developing and evolving to meet these needs. As such the role of general practitioner in the future will be that of co-ordination between other health care providers as well as social services and rapid convenient access to GPs at a time that suits the patient.
In order to provide these services effectively GP practices will start working as groups in primary care networks to provide a wider range of services for patients outside of hospital. This will ensure individual practices are better supported to provide the additional capacity, flexibility, specialisation and economy of scale required, working with wider networks of providers to deliver high quality, integrated care.
For patients this will mean a different experience of primary care services. People will be able to book appointments and view their own care records online, there will also be access to new services in the evenings and weekends at a number of different locations. Patients will be asked questions about their long term health goals, and will experience being more actively provided with advice on how to achieve these goals, including which services and professionals are available to them. Those with more complex conditions will see better continuity of care, only having to tell their story once. Professionals involved in their care will be better supported to work together and share information to ensure care is co-ordinated around patient needs.
These new models of primary care are very much in the development phase, but there is no doubt that General Practice of the future looks radically different. It has to, in order to meet the long-standing vision for high quality first point of contact healthcare services to every person, irrespective of age, health, race, social status or ability to pay.