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Formerly Director of an acute trust Ben was CEO of Nene CCG for 8 yrs. He is a founding director of Ockham Healthcare and programme director of the Practical Steps development programme

@benxgowland

Targeting ‘unnecessary’ general practice consultations isn’t the answer

NHS Alliance has produced a new document ‘Making Time in General Practice’. But is the report really about ‘making time’ for general practice (which the government has latched on to), or is it about developing the model of general practice as a whole?

There is much to commend about the recently published ‘Making Time in General Practice’ NHS Alliance document. The focus on the practical steps that practices, commissioners and national organisations can take to support general practice tackle the challenges it currently faces is urgently needed. If action isn’t taken, things not only won’t improve, they will continue to get worse.

But the prime minister’s announcement that coincided with the publication of the report focussed on ‘removing bureaucracy and form filling’, and ‘unnecessary’ GP appointments. For me this detracts from everything that is good about the report. We have been trying to remove bureaucracy for years, without success. Nothing within report convinces me that this time it will be different. More importantly, do we really want to stop these ‘unnecessary’ GP appointments?

According to the report 27% of GP consultations are ‘avoidable’. But is this a helpful segmentation of GP consultations? Just because a GP consultation could be avoided, should they be? Putting the potentially circular category of ‘others in the practice’ aside, the top three categories of avoidable consultations are ‘self care/pharmacy’, ‘social prescribing’, and ‘benefit appeals’. Are we sure we don’t want these consultations within our model of general practice? Are we clear where we would rather these patients present?

The concept of ‘avoidable attendances’ to A&E has not helped us over the last 10 years and I doubt it will help general practice. Narrow definitions of what general practice should and should not be doing are understandable but potentially unhelpful when considering the needs of the system as a whole. Conversely, understanding the segments of present day demand is extremely valuable when considering how general practice now needs to develop.

At the same time, the report provides really useful advice and guidance as to how the model of general practice can adapt. Practices can work together to free up time by sharing tasks and responsibilities. Practices cannot continue to operate in isolation; they have to build partnerships with the rest of the system. The practice team can be extended to include other roles.

Many of these extremely helpful changes identified in the report are more about changing the model of general practice to meet the new demand that exists, rather than identifying what the existing model can stop doing in order to cope. The report is really about enabling the evolution of general practice into a new model of delivery, rather than ‘making time’ within the existing model.

What the report is seeking is action, and help for general practice to evolve so that it can meet the new pattern of system demand that now exists. What I hope the report leads to is not a new industry in analysing ‘avoidable’ GP consultations, or soundbites with which the government can make meaningless platitudes to general practice, but support and resources that will enable general practice to emerge from its current crisis, and at the same time better meet the needs of those it serves.

 

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