New models of care are needed which both reflect the needs of local communities and the challenges of the future. The practices of the future may look very different from those both GPs and patients have become used to and, as the many GPs who are at the forefront of driving through these changes recognise, this will require new ways of working.
In some areas, GPs are already working as part of larger structures, like GP networks, working more collaboratively with other parts of the health service and under different contracting arrangements. GPs are at the heart of these new ways of working, driving these changes through for the benefit of patients.
The key test that any new ways of working must pass is that they adhere to those core principles of general practice which both patients and doctors value.
Moving towards a collaborative care model
To work effectively in the future, the independent contractor model of general practice needs to develop and evolve. The core strengths and successes of general practice need to be built upon, in particular: the connection with a local community which enables GPs to be strong advocates for their patients; the involvement of community and secondary care clinicians in an integrated collaborative model of working; and a model of working that enables innovation and efficient working. General practice should also be at the heart of a stable care system – one that is attractive to doctors considering a career in general practice.
The building blocks of this collaborative model are larger practices working closely with bigger teams built around each practice. These larger practices form networks, which, in turn, work with other health and social care providers in the locality to integrate care. These building blocks do not necessarily and consequently lead into one another. They can lead to the development of other models of care, and operate in isolation to the benefit of patients.
Building teams within and around practice
We believe the following steps could help practice teams realise their full potential:
- Invest in training additional staff for general practice and community-based services, including healthcare assistants, practice and community nurses, care co-ordinators, pharmacists and patient advocates, to help GPs manage current and future workload pressures and provide greater support for administrative tasks and diagnostics.
- Provide long-term funding from local commissioners and NHS England to allow practices to take on these additional staff.
- Build teams around each practice and within each network, with practices closely collaborating with these enhanced teams for the benefit of patients.
- Take action to promote a culture change within the wider NHS, leading to a greater focus on, and valuing of, community-based delivery of care.
Creating GP networks
The BMA has already produced considerable guidance on networks. We believe the following steps could help to realise their full potential:
- Support practices to create provider organisations or GP networks with clearly defined funding to both ensure GP clinical time is not lost and cover the running costs of the organisation.
- Provide project management support to all networks from the early stages of their development.
- Offer education and training to network leaders.
- Provide support around bidding for and delivering primary care contracts.
Utilising new technology
New technology can play an important role in improving patient care and potentially facilitate the development of new models of care and closer working with other providers to deliver a more integrated service. We believe the
following steps can help to realise its full the potential.
- Support practices to ensure they have the necessary time to investigate, plan for and implement new technological developments.
- Provide ongoing assistance to practices to maintain, update and review technological developments.
- Help patients to use web tools and other systems and other health and social care services, which will also enhance health literacy and self care.
- Provide clearly defined financial support to practices for major investment in new technology, including ensuring practices have the necessary bandwidth.
- Share good examples widely to help practices learn from the experience and expertise of others, and to avoid unnecessary duplication of effort.
- Ensure full transfer of electronic health records between different practices to reduce or eliminate the need for paper records.
- Enable appropriate access to patients’ electronic records in urgent care situations and other health and care settings. Sharing and access to patient records has to be
carefully planned and done in a way that has confidence of patients and doctors.
- Expand mobile technology to enable GPs to access patients’ records when away from the surgery e.g. for patients that are housebound.
Building modern premises and infrastructure
Modern, high-quality care requires modern, high-quality practices and infrastructure. We believe the following steps could help to achieve this:
- Provide a long-term commitment to an infrastructure fund beyond the current timescale, with a comprehensive longerterm premises strategy to ensure that general practice and the wider primary care teams can deliver the changes that will be necessary.
- Offer more premises through the NHS or a third party to meet the needs of GPs who do not want to own practice premises.
- Co-location of other healthcare professionals in the same buildings as GPs, working as a wider primary healthcare team.
- Developing local primary care hubs that practices can access for diagnostics, extended care in the community and out of hospital services.
Investing in primary care
Investment in primary care has gone down significantly in recent years and recent small increases have not addressed the resulting shortfalls. We believe the following steps are needed to address this:
- Provide a sustained, year-on-year increase in NHS funding to general practice.
- Ensure this funding increase is available in the long-term on a recurrent, equitable basis for practices, allowing all patients to benefit.
- Uphold principles of equity and sustainability for all practices and patients, and CCGs to be held to account for their use of funding in terms of the benefits to patients or reductions in pressures elsewhere in the system.
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