Dr Charles Alessi, newly appointed chairman of the National Association of Primary Care (NAPC), said: ‘The report’s recommendations are, in many ways, both brave and challenging; challenging of the government, as well as the professionals who work in the service, and the NAPC supports them wholeheartedly. It is time to tackle with determination unwarranted clinical variation, as well as poor care in general from any NHS professional.’
Dr Richard Vautrey, GPC deputy chairman, said: ‘We have seen many of these reports come and go and one of the themes is what will actually happen in reality. Much of what is in this report is not rocket science and appears quite straight forward. But delivering it could be another matter altogether.’
Dr Johnny Marshall, former chairman of the NAPC, added: ‘The report’s recommendations are much needed and welcomed. They are challenging, yet sensible and practical. The NHS should now proceed with their implementation.’
Nick Goodwin, senior fellow at the King’s Fund, said: A lot of this isn’t rocket science, this is a list you could have drawn from the literature about what you need to do. But this process has enabled integrated care to now be accepted as a policy goal. It does take it a step forward and the government response is positive. It creates a mark in the sand that the national policy going forward will be around integration. We shouldn’t underestimate that. But it stops a little bit short on some aspects and there is not enough oomph that describes the urgency and the different approaches to meet the objectives.'
- Click on key issues in the report and read the reaction: Integration; Public health; Information and Education
- Overhaul GP contract to promote integration.
- Look at ways to pool health and social care budgets.
- Clinical commissioning groups (CCGs) must show ability to integrate before authorised.
Reaction: The DH has backed the NHS Future Forum’s recommendation to update the GMS contract to encourage integration, but GP leaders remain unconvinced. GPC deputy chairman Dr Vautrey says using the contract to encourage integration is the ‘wrong way to go about it’. He says many practices already have arrangements in place to work together. He says: ‘There isn’t a need for contractual change. It would also bring into question the independence of individual practices, which is what patients value’.
Meanwhile, Wessex LMCs chief executive Dr Nigel Watson says it is right that CCGs demonstrate an ability to integrate before they are granted full statutory powers. But he says it is inappropriate to pool health and social care budgets. He says joint commissioning should only be carried out on certain services. ‘There are insatiable needs for both health and social care and the concern would be how you would control that if whole budgets were pooled,’ he says.
- ‘Make every contact count’ and use every consultation to promote healthy lifestyle choice.
- Build promotion of healthy living into day-to-day NHS work.
- Strengthen public health QOF indicators.
Reaction: RCGP chairwoman Dr Clare Gerada was the first to voice her concerns about the ‘make every contact count’ proposals. She remains unconvinced by the evidence for the proposals and says lecturing on lifestyle choices may deter patients from making appointments. She says: ‘There's some evidence for low level drinkers and for smoking that brief intervention works,’ she says. ‘But for exercise and obesity the evidence is minimal. We need a population-based approach - looking at issues like pricing and advertising.’
But Jo Webber, NHS Confederation deputy policy director, agrees that the NHS needs to focus more on prevention.
‘Healthcare professionals can play a big role in encouraging healthier lifestyles through their day-to-day contacts with patients,’ she says. ‘They need to think about preventing the next health problem as well as dealing with the illness that is there.'
- All patients to have access to medical records by 2015.
- Hospital discharge summaries made available to GPs.
- Use patient comments on all forms of social media as means of improving services.
Reaction: Dr Vautrey says while most patients already have access to their records the plan to allow them to access and edit records online raises a number of security issues. ‘It’s a principle that I generally support, but there are a number of issues around actually developing a system that is safe and appropriate,’ he says.
Dr Watson also pours doubts on whether it is a service that patients genuinely need. He says: ‘There are things in the patient record that are sensitive and I don’t find an overwhelming desire from patients who want to look at their full record and make notes on them.
‘It would be far more appropriate if the NHS focused its energies on ensuring all GPs get discharge summaries from hospitals.’
Dr Vautrey also says the plan to use patient comments on Twitter and Facebook to inform how services should be improved should be handled with caution.
‘We would get very skewed result if we simply relied on these comments. We must ensure we get a balanced view rather than just hear from those who shout the loudest,’ he says.
- Extending GP training should be looked at as matter of urgency.
- More flexible NHS career pathways.
The issue of extending GP training has been rumbling on for many years, but it now looks like to be thrust into the spotlight again. The DH has backed the NHS Future Forum’s call for the issue to be looked at as a ‘matter of urgency’. Unlike other recommendations, this call has received unanimous support.
Dr Watson says extending GP training must not just result in ‘extra hurdles or exams’ for trainees. ‘It must allow trainees to get better exposure to lots of different patients and have the protected time to learn from that,’ he says. ‘It must also provide experience in commissioning and leadership skills.’
Dr Watson says it was good that the report did not specify how long GP training should be, as it is unlikely it would be extended to five years in the present economic climate. ‘It means it can be up to negotiation and could initially be extended to four years,’ he says.