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Transforming general practice: Setting the context

Dr Rebecca RosenSenior FellowThe Nuffield Trust

May 15th 2013

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Multiple drivers of demand

Lack of access to social care

New medical

technologies

Aging populations

Rising patient expectations

Rising prevalence of

chronic disease

New providers/ supply induced

demand

Primary care

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Relentless rise in number of GP consultations

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Changes in workforce and working practices

Key findings from M&E survey of GPs 2012.

Majority work 8 – 9 sessions/week

If working 2 sessions/day, > 10hrs

Believe quality remains high but workload is challenging this

Workload due to admin, QOF, LTCs and exceeding appt times

Many believe that more capacity would help to quality/ burnout

Concerns expressed about ability to recruit GPs in futureMany report changing skill mix in response to increasing demand

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The Primary Care Paradox....

‘... a paradoxical situation: the tension between the relative weakness and un-attractiveness of this level of care versus the intention to assign critical strategic functions to it’

From:Primary Care In The Driver’s Seat? Saltman, Rico and Boerma (eds) 2006

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Primary care ‘fit for the future’

Attributes

• Comprehensive

• Patient-centred

• Co-ordinated

• Continuous if required

• Accessible

• Safe and High Quality

• Population focused

• Adapted from Agency for Healthcare

Research and Quality 2013

Sustainability

• Financial

• Workforce

• Public trust

• Fit with wider health system

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Mechanisms for change

• Innovation from within general practice• Extended scope and scale of primary and community based care

• Payment systems and contracting arrangements• CCG initiatives to commission new services from primary care

• Acute sector innovation • Hospitals setting up primary care services and integrated systems

• Regulatory drivers of change • Competition rules driving CCGs into competitive procurements

• New technology / information technology • Creating opportunities for new types of (rural) clinical encounter

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How can new models of general practice achieve these design principles?

Two broad organisational arrangements emerging for GP:• Large partnership s

• Networks

Common challenges, including• Financial constraints

• Uncertain regulatory context

• Workforce pressures

• New interface with commissioners

New opportunities, including • Clinical commissioning driving collaboration between practices • Policy focus on Integrated care• Changing expectations of general practitioners

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Hostile policy context, no clear view of role of primary care in national health system

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