Debate surrounding the future of general practice is usually rooted in the context of the primary care workforce, the introduction of new roles and developing practitioners with a new skill-mix.
Such solutions are rooted in the medical model of health. I share the Marmotian view that health care is just one dimension of improving individual and population health.
As GPs, we often consult with patients who cannot be helped by our services. We are also often unable to effectively signpost patients or help navigate them to services that can support them. Consequently, I believe the future involves working as part of a collaboration of services – delivered optimally by co-location. Provision of these services would be based on the geographical location of patients and include amenities already provided by local authorities – housing, social care, public health. Other allied health care services would also be part of these collaborations, for example health visitors, district nursing and community mental health.
Service reconfiguration alone, however, fails to tackle the defining issues for general practice of the last decade – workload and workforce. Most suggested new models of care require additional staff, staff who are not currently forthcoming. Therefore, it is not hyperbole to state that any and every future vision of general practice perishes if workforce issues are not effectively tackled.
The scale and complexity of the challenges are enormous: multimorbidity of patients, causative factors of rising early retirement, patient expectation of access and treatment, improving access and wait times to psychological services, the impact of similar workforce challenges in district nursing, to name a few. Technology will undoubtedly be a part of the solution to these challenges. GPs broadly think it will help with administration of work rather than direct clinical care. However, the greatest impact of technology will be for individuals who want to influence policy.
How many GP appointments are available nationwide today? How many appointments have been cancelled prior to today? Practices across the country use a variety of software to book appointments and record consultations. Some may individually audit data but are currently not mandated to provide that data in a uniform and comparable way. Being able to provide answers to these questions enables individual doctors and other interested parties to suggest innovative policy if the political agenda and priorities are right.
Complaints from GPs of being overworked can be interpreted by some as an opportunist call for a salary uplift, rather than a genuine distress signal. Data evidencing increasing patient demand – for example, average length of time from booking to appointment – is helpful in reframing surveys of GP burnout into a politically advantageous format: ‘more GPs are needed to reduce waiting times’. After all, waiting times for appointments are what our patients talk about and consequently the language that politicians are most likely to understand and respond to. That said, digital health proponents can use the same information to frame policy in their interests: ‘more video consultations are needed to reduce NHS GP workload.’
Promoting solutions to these issues in the policy arena requires the development and championing of GPs, and other advocates of general practice, who can understand and navigate the policy process. GPs who readily accept that the delivery of health care funded from general taxation is inherently a political issue. GPs who accept that the production of evidence, though helpful, is not often the defining factor in influencing policy. GPs who are prepared to form alliances with other groups and campaigners to advocate for services that influence the workload in general practice, for example community mental health services.
This is where the future of general practice truly lies. If general practice is to thrive in the years to come, failure in this arena is not something we can contemplate.
This is an edited extract from an article by the author published in InnovAIT.