Harpreet Sood and Mahiben Maruthappu are Senior Fellows in the office of the Chief Executive for NHS England.
Over the last decade, the NHS has achieved a lot. It has been ranked the number 1 healthcare system in the world, public satisfaction has almost doubled, cancer survival is at its highest, and early deaths from heart disease down by 40%. Central to this achievement has been general practice as it continues to be the cornerstone of the health system, with 99% of the population registered with a general practice today.
There are an estimated 340 million consultations that occur in general practice today but the demand across the health system is rising. An estimated 70% of the NHS budget is spent on long term conditions but the number of people of choosing to become a GP is not keeping pace with the growth in funded training posts.
Therefore as a health system we need to look for innovative ways to keep up with the demand and ensure primary care remains a key component of the NHS.
Models of care
Primary care of the future will build on the traditional strengths of ‘expert generalists’, proactively targeting services at registered patients with complex ongoing needs such as the frail elderly or those with chronic conditions, and working much more intensively with these patients. Future models will expand the leadership of primary care to include nurses, therapists and other community based professionals. It could also offer some care in fundamentally different ways, making fuller use of digital technologies, new skills and roles, and offering greater convenience for patients.
Additionally, the NHS will need to dissolve traditional boundaries that exist between primary care, community services and hospitals. Long term conditions are now a central task of the NHS; caring for these needs requires a partnership with patients over the long term. In many areas also, primary care is entering the next stage of its evolution. Group practices are forming federations or networks and are starting to offer primary care at scale. These Multispecialty Community Providers (MCPs) would become the focal point for a far wider range of care needed by their registered patients.
In addition to an increased demand in healthcare, there is an estimated current shortfall of GPs in England. The RCGP, BMA, Health Education England and NHS England have released the 10 point plan which will help retain and recruit GPs into the workforce. Some of the key highlights include promoting general practice, improving the breadth of training, investing in retainer schemes, improving the training capacity in general practice and introducing new ways of working.
In Britain 86% of adults use the internet but only 2% report using it to contact their GP. To promote the use of technology in primary care, NHS England is taking the following steps:
- 97% of GP practices are now offering online appointment booking.
- Patients being able to view their full coded medical record including option for them to download into third party applications when required.
- Bringing together hospital, GP, administrative and audit data to support the quality improvement, research, and the identification of patients who most need health and social care support. Individuals will be able to opt out of their data being used in this way.
- Technology, including smartphones, can be a great leveler and, contrary to some perceptions, many older people use the Internet. NHS England is taking steps to ensure that we are building the capacity of all citizens to access information, and train our staff so that they are able to support those who are unable or unwilling to use new technologies.
Primary care research is an important priority for the NHS and there is the opportunity to radically cut the costs of conducting Randomised Controlled Trials (RCTs), not only by streamlining approval processes but also by harnessing clinical technology. There is therefore a case for more support for observational studies and quicker lower cost pragmatic RCTs embedded within routine general practice and clinical care.
Plans for 2015/16
The NHS commitment to primary care services has been highlighted in the NHS England Business Plan and includes the following:
By March 2016:
- Improved access to GP through delivery of the PMCF wave two pilots and investing in primary care staffing and infrastructure with insight generated from the evaluation of wave one – testing wide variety of ideas – more appointments in evenings and weekend, plus option for video, email and telephone consultations, better sue of telecare and health apps and improved integration of IT services
- Investment in GP estates, IT and delivery of the 10 point GP workforce action plan to support better quality care
The 44th #sapcasm runs from Wednesday 8th to Friday 10th July 2015
Very thoughtful analysis of future challenges and opportunities in the UK. I feel that we face many of the same opportunities and challenges in Canada but will be handicapped in pursing pan-Canadian innovation because of the P/T fragmentation of healthcare in this country.