Fragmentation and rapid access schemes are undermining GP care, says think tank

Rapid access schemes and the rise of primary care services for specific patient groups are undermining GPs' ability to manage complex patients and keep them out of hospital, according to a think tank.

NHS policymakers are convinced that traditional general practice needs to 'think big' - working in larger-scale models to 'meet patient expectations of quick and easy access to appointments, make use of new technology and become big enough to invest in the managerial capacity and equipment to put all this in place', a Nuffield Trust report says.

But it warns that this increasingly 'segmented' approach to general practice, 'splitting out different patient groups and adapting services to meet their particular needs' risks pulling more and more of the scarce GP workforce away from traditional roles that are a key factor in limiting NHS costs.

'Policies designed to segment general practice often emphasise faster access to quick, transactional, "see and treat" encounters,' the report says. 'The rapid growth of these services is pulling GPs away from the expert "medical generalist" role of general practice that is a defining characteristic of list-based primary care.'

GP gatekeeper role

The report, Divided We Fall, says GP-registered lists and the gatekeeper function can deliver better health outcomes at lower cost. Focusing on rapid access could raise costs - at a time when NHS funding is tight - because 'fewer resources are left to deliver medical generalist and multi-disciplinary care', it warns.

The report urges GPs to build 'systems to spot complex patients for whom continuity of care may improve outcomes and encourage them to stick with a single doctor or clinical team'. It also calls on GPs to use technology to improve convenience and outcomes where possible to avoid patients seeking faster access elsewhere, and for practices to work together to improve access while maintaining continuity.

GPC chair Dr Richard Vautrey said the Nuffield Trust's findings echoed concerns set out in the BMA's Saving General Practice document.

'GPs strive to provide safe, high-quality and timely care to all of their patients despite current pressures,' said the GPC chair. 'As this report notes, "fast-track" services that aim to improve access will benefit some patients but are unsuitable for others, particularly those with complex health needs.

GP access

'Over the last decade government initiatives have focused on access, but have not invested sufficiently to deliver the workforce and extra capacity needed to meet rising demand.

'We should be investing in practices that are embedded at the heart of the local community and offer holistic continuity of care. This would allow surgeries to expand their staff and meet the needs of the whole population, not just a subsection of it.'

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