General practice cannot escape need for reform, NHS England warns

GPs must embrace changes to the way they work to free up appointments and relieve pressure, a senior NHS England GP has said, warning that more funding and an expanded workforce alone cannot reverse the crisis facing the profession.

The GP Forward View offered a ‘marvellous vision for the future’ – but general practice ‘needs to change’ to make it happen, according to Manchester GP Dr Robert Varnam, head of general practice development at NHS England.

Speaking at the Health+Care conference in London on Wednesday, Dr Varnam said patients with long-term, chronic illnesses are the key force driving GP pressures. The problem is that the NHS ‘was not set up’ to deal with patients with these long-term conditions, he warned.

‘When the NHS was set up, patients got sick, were given a cure, then they'd go away back to normal life,' he told the conference. 'They might need the NHS again a few years in the future if they get sick again.

‘But now morbidity is on the rise. Patients are older, more likely to have long-term conditions – and several of them.’

GP workload

The pressures have grown as the volume of work GPs are expected to do has outstripped capacity. This has led to costs in general practice rising ‘faster than any measure of inflation’ – and ‘neither relative funding nor the workforce’ has kept up with demand, he said.

But these ‘unparalleled pressures’ come hand in hand with ‘unparalleled opportunities’, Dr Varnam argued.

He argued that the scale of change needed could not be achieved simply by piling more money into general practice and bolstering the workforce.

‘The general assumption about how you make something happen is more money, more people. By and large, we’ve achieved amazing things through "more". We’ve worked harder, faster and longer. But we've reached the point where doing more of the same is not going to cut it.

‘We do need more money. We do need more staff in primary care. But just having more people prescribing higher and higher doses of medications is not enough. We need to do things differently.’

GP efficiency

Changes to the way GPs work could enable key savings to make GPs work more efficiently, he argued.

A survey of over 5,000 GP consultations carried out by NHS England found that a quarter (26%) could immediately be identified as avoidable – for example because patients would be better served elsewhere within the health system (7%) or they could be treated with self-care alone (6%).

Simply managing these appointments differently could help free up GP appointments.

He called for systems to be put in place to allow GPs to share more between themselves what works and what does not to help spread effective ways of working.

‘Practices are all working in silos. The NHS is not sharing information on solutions practices have made – this is partly why there's so much stuff in the Forward View.

NHS England has identified 10 ‘high impact actions’ – areas that can be improved to release GP time for patient care. These include active signposting, new consultation types and social prescribing.

It has developed an online resource for practices to share information on case studies and successful ideas for innovation to help allow for greater shared learning.

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