2017 has been a year of fear and pressure in many places – GPs are contemplating early retirement, many others are worried about stress and burnout and, combined with a decline in numbers already, this means that primary care is on the edge of collapse.
It has been confusing to see some groups calling for judicial reviews of accountable care systems, which are developing from pilots, new care models and STPs. The spectre of privatisation looms large behind every new initiative. Our patients publicly espouse love and affection for the NHS, but see no conflict with placing increasing demands on primary care before self care, entitlement to medicines before investment in health and access before continuity.
As a profession we are responding with fight, flight or freeze in almost every situation. The RCGP chair promised to ‘keep up the fight’ for resources to assist GPs in caring, CCG clinicians are disappearing into federations or other lifeboats on a daily basis and initiatives such as physician associates are being frozen by the processes required to legitimise them in the eyes of traditional practice.
So, all in all 2017 was not a stellar year for primary care.
Looking ahead, there are multiple opportunities if only we can create the space to engage with them.
The next twelve months will see the mainstreaming of electronic or online consultations – I predict there won’t be a practice not taking electronic access on board by the end of 2019.
There is money for it, and if it favours the young then so what? It might stop them drifting away to new wave practices arising from partnerships between existing practices and tech companies, such as GP at Hand, which offer near instant access. Cynics would argue that online tools are simply internal cherry picking for those that can access them, but as long as its internal that's OK, isn’t it?
Apps face a similar mainstreaming challenge, but I predict they will be big news. Highly activated patients can initially consume large amounts of resource, which is useful if there is a health gain to be had, but once the gain has been established the activation can enable tools which are armslength and app-based to flourish.
Access via apps can enable self care, but individuals will choose apps that best suit them and there are a lot to choose from. Right now we don’t have enough science to enable app choice and recommendation above the level of ‘here’s something I tried and it worked’. We also still don’t have one clear standard for the assessment and approval of evidence-based, safe apps. But I predict that by the end of 2018 we will have our first ‘Professor of Technotheraputics’ in post.
I also suspect that by the end of 2018 the control of the gatekeeper will pass to agencies such as the ambulance services and 111. Currently patients book consults, call backs and interactions directly. But I think that by the end of the year many practices will have direct booking by 111, ambulance and out-of-hours services, who will redirect the misplaced non-acute demand to the daytime GP. After all, thats our job isn’t it?
- Dr Chris Mimnagh is a GP in Liverpool and head of clinical innovation liaison and deployment at The Innovation Agency, the academic health science network for the north-west coast.