Talk to anyone about the thing that irritates them about General Practice and the first thing they mention is appointments. It’s not just the patients! The staff also feel the pressure on appointments.
How can we increase capacity in General Practice so that there are enough appointments when there are a falling number of GPs? What is ‘enough’ appointments anyway?
There are those who say we should also increase choice for patients in where they go for primary care – “more surgeries” is the cry.
The digital solution
There are several websites or Apps, such as http://askmygp.uk/ that allow people to enter their symptoms and answering some questions allows the GP to work out the best way to help. These may advise the patient as to who is best p[laced to help them. This may create some spare capacity so that those who need to see a GP, such as people with complex needs, can do so.
The ‘do it on the phone’ solution
Instead of seeing a GP or other healthcare professional the patients the consultation will take place on the telephone or via Skype or some form of webcam interaction or by email. There are a number of solutions available to manage phone calls such as http://gpaccess.uk/ & http://www.digitallifesciences.co.uk/
Both of the above solutions could also be considered the ‘managing the demand side’ solutions.
The Changing traditional General Practice or more GP surgeries solution
(‘more of the same’)
This solution is about increasing the number of GP surgeries so increasing the number of appointments and increasing choice for patients.
So how do you go about developing a new surgery? You need to raise the cash to buy or rent a suitable building. You need to recruit the relevant staff. That means a full multi-disciplinary team to provide a 21st century service. The cost of a building for 6000 patients could be around £1.5 million but could be more if an extended team is required.
This investment has to come from somewhere. There is the Prime Minister Innovation Fund (now with a smart new name) that was for existing practices if they developed 7 day working. There has not been any funding for new builds from central government for the last 25 years or so. If there is a new housing development and if the local planning authority is up to the mark such a new building could come from ‘planning gain’ and built into the cost of the development. However the developers would only build the bare minimum – based on 1990’s requirements.
However there is still the problem of revenue costs which has to currently come from the NHS. Unless, of course, there is a change in the views of the public on private healthcare or health insurance.
Finally there is the problem of recruiting the staff. GPs and nurses are hard to recruit or retain at the moment.
The nuclear solution
One way of increasing appointments with a GP is to do the reverse. Patients will only see a GP after they have been seen by another health care professional, (a nurse, a pharmacist or an emergency care professional). They would refer patients onto a GP as appropriate in the same way as a GP refers to a consultant. Thus the GPs would see fewer patients.
- Reduce unmanageable & unsafe workload
- Improve perception of General Practice as a career option for junior doctors & nurses.
- Reduce administrative & regulatory burden.
- Return to self-management of minor illness.
There is a final solution
There could be real and meaningful investment to restore the percentage of the NHS budget spent on General Practice back to the 10% it used to be.
So how will these solutions increase choice and capacity?
Really the only solutions to do that are ‘the more of the same’ solution of increasing traditional general practice by increasing the number of practices.
This is highly unlikely given that there is no investment in new building and real problems in recruiting new GPs. If the government does not invest will private investors take that role? Again, in my opinion, I think that is unlikely as there is no profit to be made from general practice at present.
Would a community enterprise or other not for profit organisations invest in general practice? That is an interesting question.
So sadly I can see no way to increase choice for patients.
Similarly the only way for general practice to survive is to manage demand rather than increase supply.
Urgent prescription for general practice