Andrew Riley was Head of Medicines Management - Stoke on Trent PCT, strategic lead Medicines Optimisation - Staffs PCT Cluster and is now Midlands & East of England partnership manager for Association of British Pharmaceutical Industry
Newly licensed innovative medicines mean that GPs will need to keep up to date with pharmaceutical innovation to better manage demand.
This article reflects the views of the author and not the view of his employing organisation nor the views of any pharmaceutical company
The NHS is facing a crisis as increasing numbers of older people require healthcare close to home and the current model of open access general practice is under immense strain as it attempts to meet the demand driven by age related morbidity and compounded by social isolation. The needs of patients become ever more complicated as they age. As a consequence the current service tends to direct a disproportionate amount of hospital based support to those with the most complex needs and there is a growing concern that existing service provision is unable to meet demand
The emphasis of the current long-term-conditions service focuses on reactive crisis intervention at the time of acute exacerbations, rather than continual supportive care for frail older patients as they begin to need more intensive support.
Re-functioning primary care
GPs often work in isolation and meet the demands of their expanding list by ‘fire-fighting’, they have honed their crisis intervention skills but to some extent this has lessened the need to step back and reconsider how their service needs to change. These factors make it necessary to explore whether there is a need for a shift from diagnosis-based care to needs based care.
Shifting the emphasis from managing the diagnosis to managing the need of older people
GPs need to consider the aspects of their service that could just as easily be provided by other healthcare professionals working alongside them with no diminution of clinical quality. Pharmacist prescribers, nurse specialists and social workers all offer different skills and are useful additions to the practice team, whose clinical skill can be harnessed to optimise care for older patients, releasing time for GPs to meet the needs of their more complex patients and open up new opportunity to maximise the productivity of their service. Other professionals can be shared between practices and employed in the new service configurations being introduced in the Five Year Forward View.
Keeping up to date with pharmaceutical innovation
Newly licensed innovative, omics-derived medicines will need to be carefully targeted at their responder cohort and GPs will need to keep up to date (and their service will need to keep pace) with pharmaceutical innovation.
NICE Health Technology Appraisals and Clinical Guidelines are often orientated toward the hospital specialist clinic as the default for the initiation of new medicines, so that patients remain exclusively under the review of a specialist. However, it may not always be necessary and specialists can maintain supervision of patients at arms-length if GPs improve their ability to monitor treatment by complementing their skill mix and improving their capability to manage new treatments.
Adopting demand management techniques will allow GPs to keep ahead of the demand curve and make primary care a dynamic environment for their service, shaped around the needs of their patients and capitalising on the opportunity that new treatments will bring to position themselves at the leading edge of healthcare innovation.
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