Our deliberative events with patients found what every GP instinctively knows: that patients want high-quality care, provided by a familiar team of GPs who know their medical history, and they want to be able to receive that care in a timely fashion when they need it. However, it would be wrong to assume that, without significantly more GPs, working differently could in itself deliver significantly greater access for patients.
So how might patients’ priorities best be delivered? Both patients and GPs believe that the core principles of general practice should be retained.
Retaining the core principles of general practice
At our deliberative events, patients wanted to see a continuation of GP-led primary healthcare and rejected the non-GP run models with which they were presented. A number of key themes emerged as patients discussed some different practice models:
- A strong desire for GPs to remain in the community.
- A great attachment to the ‘personal touch’ offered by GP surgeries.
- A great deal of respect for, and faith in, GPs’ ability to run services and concern that other parties would not display the same level of dedication or retain the same ethos.
Patients empowered to care for themselves
Patients know that responsibility for their care does not rest with doctors alone. At our events, patients felt more should be done to promote self-care and recognised that the inappropriate use of services is a major contributor to the pressures on general practice. We believe the following steps could help empower them to do so:
- Launch a government-backed national self-care strategy, in conjunction with patient groups and the BMA, to help more people understand how to look after their own health and free up GPs to look after those patients with the greatest need, in particular the most sick and vulnerable.
- Encourage practices to promote self-care. This could range from online resources and patient materials to telephone triaging and different appointment systems - to ensure that patients feel more confident about managing their own care at home when appropriate.
- Commissioners designing care pathways which ensure that patients do not see their GP practice as their first call in all circumstances. Clinical Commissioning Groups (CCGs) have a large role to play in signposting patients to the place where they can get the most appropriate care.
Improving urgent care
Urgent care is provided by GPs day and night on every day of the year, either through their practices or via out-of-hours (OOH) organisations covering their practice area.
Just as practices have been coping with an increased workload with reduced resources, GP OOH organisations have had similar pressures.
Improvements can be made to optimise access to appropriate urgent care in and out-of-hours and enhancing self-management.
This could be achieved by:
- CCGs commissioning integrated models of OOH care, bringing together community nursing, social care, walk-in centres, pharmacies, OOH general practice organisations, NHS 111 services, minor injury units, ambulance services and hospital emergency services.
- Using Prime Minister’s Challenge Fund money to support urgent care service development rather than creating a parallel routine care weekend service.
- High-quality telephone triage for urgent care as a first point of contact, led by clinicians - not solely by computer algorithms – to enable patients to access the most appropriate service, enhance self-care and management, as well as reducing unnecessary referrals to GP practices.
- Taking Accident & Emergency minor attendances out of PbR (Payment by Results) and tariff arrangements and giving CCGs the responsibility and the budget for commissioning an integrated community and hospital service for unscheduled care.
- Ensuring consistent health and wellbeing messages to patients through better co-ordination of information materials provided by different parts of the NHS.
- Establishing a minimum clinical staff to population ratio for OOH organisations.
- Enabling patients and clinicians working in OOH settings to access their electronic health record.
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