Viewpoint: how primary care must evolve to fit changing NHS

By Dr James Kingsland and Graham Roberts, 13 June 2013

Writing for GPonline.com, NHS Clinical Commissioning Community lead Dr James Kingsland and Assura Group chief executive Graham Roberts warn that Pressure on the NHS is rising and ministers can no longer simply paper over the cracks.

Dr James Kingsland and Graham Roberts

Dr James Kingsland and Graham Roberts

The growth of the elderly population is a ticking time bomb. We have known for decades that by 2030 there will be as many as 30 million people aged over 65 living in the UK, and the healthcare sector is already feeling the pressure. While it’s clear that rethinking investment and support from central government is required, some of the current suggestions to improve care for our elderly population are not practical. They are simply papering over the cracks with regard to the challenges that the primary care sector is facing.

Primary care home

The proposal from the health secretary, Jeremy Hunt, is that all vulnerable elderly people should have their own ‘named individual’ care worker from as early as next year. This person, who would be responsible for co-ordinating all of their health and care needs, is a well-intentioned idea, but is logistically impossible, both practically and financially. Training enough staff to give one-to-one care to such a large proportion of the population in England would require massive investment and disregards the variable success and international evidence about the effectiveness of ‘case management’. Moreover it doesn’t address the changes that need to be made to the workings of the primary care sector itself.

The suggested extension of out-of-hours care is also addressing one small part of the wider issue. Increasing the availability of healthcare professionals will not be effective, as long as the services remain limited by physical and medical infrastructure. The solution may be an idea that is neither new nor novel, and is gaining increasing popularity in the US. This is the notion that GP surgeries need to evolve into something that could be described as the ‘primary care home’.

Patient-centred approach

The primary care home would be a venue in the local community (i.e. the general practice), which would be able to provide an elderly person with more personal care than they can currently access at a GP surgery. The model is patient-centred, with a team-based approach to care that is co-ordinated, with minimal outsourcing requirements. It would be somewhere that meets the large majority of the patients’ needs in one site, providing diagnostics and urgent care, as well as a multidisciplinary offering, which encompasses services such as physiotherapy, occupational therapy, citizens’ advice and counselling. Third sector support services such as Age UK could also have space on site, helping patients deal with issues that come with the aging process, such as grief, loneliness, isolation and depression.

The aim would be to provide more and commission less. The key difference in this concept, as opposed to Jeremy Hunt’s suggestion, is that rather than giving an elderly patient one individual ‘broker’ of services while they move between hospital, community services, care home or GP surgery, they instead receive an integrated expansive service at one location where they register for care. The GP would be able to focus on the long-term condition management of their patient, co-ordinating the team of healthcare professionals that provide for all their needs, rather than simply being forced to repeatedly refer ‘the case’ to other parties. This would result in less upheaval, fewer transactions and less fragmentation, which would surely be of more benefit for vulnerable elderly patients.

Develop GP premises

The one thing that limits this vision is the current state of the primary care estate. Only an estimated 20 to 30 per cent of current stock has the appropriate capabilities to be able to expand services in this way. Although more traditional premises, such as older converted residential properties, receive consistently high satisfaction reports from patients, the requirements of today are very different to the requirements of 2030. The primary care estate has to be ready to expand to the changing needs of the British population, and in order for that to happen major developments need to emerge.

We can’t keep avoiding this issue forever, and our response has to be effective, rather than a token gesture. Healthcare professionals are committed to providing for patients of every age, and the government must ensure that they have the appropriate level of support to do this effectively.

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