A new dawn for general practice?

The RCGP set out its vision for the profession's future in a wide-ranging report on general practice. So what will GPs be doing in 2022? Nick Bostock reports.

As the NHS celebrates its 65th birthday, it is entering what the RCGP identifies as a new era.

Over the next decade, patients will face 'more complexity, more choice and more uncertainty and will rely on the expertise, skill and compassion of their GP like never before'.

The college has called for 10,000 more GPs and a sharp rise in funding to help the profession absorb the pressure.

But to remain fit for purpose, it says, general practice must evolve, not simply expand.

So what is the RCGP's vision for general practice in 2022 and how realistic is it?

Integration

Integration has been the NHS buzzword of choice in recent years, and unsurprisingly, features heavily in the college's blueprint for primary care - The 2022 GP.

The 20th century model of healthcare - splitting up hospital and community-based care, as well as health and social care, is 'outdated', the report says.

'We are moving instead towards a 21st century system of integrated care, where clinicians work closely together in flexible teams, formed around the needs of the patient and not driven by professional convenience or historic location.'

GPs will increasingly work in federations, leading multidisciplinary teams encompassing nursing and hospital staff, using electronic records to support co-ordination of care.

Contractual arrangements will be varied, with many GPs employed in salaried roles by federations, foundation trusts, and third or private sector providers, alongside independent contractors, the report suggests.

Adapted GP role

The RCGP is clear that as part of this shift, 'the role of the GP will need to be adapted'. The report, co-authored by RCGP chairwoman Professor Clare Gerada, outlines a vision of the 2022 GP as an 'expert generalist'.

This new breed of GP will be trained to manage increasingly complex patients with chronic conditions and polypharmacy, handling 'urgent and routine needs', and providing 'first-contact care to the majority of children and those with mental health conditions'.

GPs can no longer stick to the 20th century model, in which they are considered 'omnicompetent independent doctors', the RCGP argues. Instead they will need to work 'as part of a family of interconnected professionals' that could include hospital specialists given additional generalist training.

Meanwhile, GPs will train to take on extended roles in core areas that need 'a generalist approach' - perhaps care of those with dementia, homeless patients or those in nursing homes.

Complex needs

Practices will also need to reshape their services to meet the needs of more and more patients with complex chronic conditions. Forming 'micro-teams' that bring together primary care, social care staff and clinicians from other specialties, such as paediatrics or mental health, could help provide continuity of care to named groups of patients in need of extra support.

This team-based approach may also provide the solution to rising rates of doctors working part time, the report suggests, through an 'increased focus on team-based continuity' and more 'buddying up' arrangements between doctors.

The standard 10-minute appointment slot will become a thing of the past. GPs of the future will offer 'flexible lengths of appointments, determined by need' and will need to 'adapt their working day to offer fewer but longer routine appointments for review of patients with complex needs'.

Online NHS

A generation of patients brought up with the internet will mean many 'will expect to interact with their general practice team virtually', with traditional face-to-face GP visits 'no longer accepted as the default way to access care'.

Better planning across federated practices will improve co-ordination and continuity of out-of-hours care, although GPs will not be required to offer direct patient-to-doctor access out of hours.

The RCGP vision also sets out plans to train GPs to have a better 'understanding of the needs of their practice population'. This could help shore up the profession's role in commissioning, amid Labour pressure to hand more control to local authorities.

Funding

Professor Gerada and her co-authors acknowledge that without substantial investment to expand the GP workforce and premises, 'the vision will be made much more difficult or will become impossible'.

Step one is winning the battle of ideas - an action plan in the report highlights a need to 'promote greater understanding of the value generalist care brings to the health service'.

RCGP council member and deputy GPC chairman Dr Richard Vautrey believes this battle will be won over time, simply because no alternative exists. 'It is economically essential for the NHS to be built on a primary care base, it's in politicians' interest to value it as the way the NHS can survive and thrive long term,' he says.

The RCGP vision is realistic, he says, because many of the innovations in the report are already being delivered by GPs in parts of the UK.

But he adds: 'One concern is that as practices struggle with workload, it is hard to develop in the way they want to, because they don't have the resources. Resources are crucial.'

The ball is in the government's court - it must invest and build on the innovation and modern working of GPs across the country, or miss out on what The 2022 GP calls 'a historic opportunity to harness the power of general practice to transform the health service we will have in 2022'.

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