Talk to
anyone about the thing that irritates them about General Practice and the first
thing they mention is appointments. It’s not just the patients! The staff also
feel the pressure on appointments.
How can we
increase capacity in General Practice so that there are enough appointments
when there are a falling number of GPs?
What is ‘enough’ appointments anyway?
There are
those who say we should also increase choice for patients in where they go for
primary care – “more surgeries” is the cry.
The digital solution
There are
several websites or Apps, such as http://askmygp.uk/ that allow people to enter their
symptoms and answering some questions allows the GP to work out the best way to
help. These may advise the patient as to
who is best p[laced to help them. This may create some spare capacity so that
those who need to see a GP, such as people with complex needs, can do so.
The ‘do it on the phone’ solution
Instead of
seeing a GP or other healthcare professional the patients the consultation will
take place on the telephone or via Skype or some form of webcam interaction or
by email. There are a number of solutions available to manage phone calls such
as http://gpaccess.uk/ & http://www.digitallifesciences.co.uk/
Both of the above solutions could also be considered the ‘managing the demand side’ solutions.
The Changing traditional General
Practice or more GP surgeries solution
(‘more of the same’)
This
solution is about increasing the number of GP surgeries so increasing the
number of appointments and increasing choice for patients.
So how do
you go about developing a new surgery? You need to raise the cash to buy or
rent a suitable building. You need to recruit the relevant staff. That means a
full multi-disciplinary team to provide a 21st century service. The
cost of a building for 6000 patients could be around £1.5 million but could be
more if an extended team is required.
However
there is still the problem of revenue costs which has to currently come from
the NHS. Unless, of course, there is a change in the views of the public on
private healthcare or health insurance.
Finally
there is the problem of recruiting the staff. GPs and nurses are hard to recruit
or retain at the moment.
The nuclear solution
One way of
increasing appointments with a GP is to do the reverse. Patients will only see a GP after they have
been seen by another health care professional, (a nurse, a pharmacist or an
emergency care professional). They would
refer patients onto a GP as appropriate in the same way as a GP refers to a
consultant. Thus the GPs would see fewer
patients.
Other solutions
- Reduce unmanageable & unsafe workload
- Improve perception of General Practice as a career option for junior doctors & nurses.
- Reduce administrative & regulatory burden.
- Return to self-management of minor illness.
There is a final solution
There could be
real and meaningful investment to restore the percentage of the
NHS budget spent on General Practice back to the 10% it used to be.
So how will these solutions increase
choice and capacity?
Really the
only solutions to do that are ‘the more of the same’ solution of increasing
traditional general practice by increasing the number of practices.
This is
highly unlikely given that there is no investment in new building and real
problems in recruiting new GPs. If the
government does not invest will private investors take that role? Again, in my opinion, I think that is unlikely
as there is no profit to be made from general practice at present.
Would a community
enterprise or other not for profit organisations invest in general practice? That is an interesting question.
So sadly I
can see no way to increase choice for patients.
Similarly
the only way for general practice to survive is to manage demand rather than
increase supply.
#GPincrisis
Urgent prescription for general practice