GPC rejects call for larger surgeries as report calls primary care 'outdated'

The GPC has criticised a report describing the current model of general practice as 'outdated'.

Dr Peter Holden: Larger practices can be more expensive
Dr Peter Holden: Larger practices can be more expensive

A King's Fund report, Transforming the delivery of health and social care, said commissioners should create a new system of healthcare and move away from the current 'outdated' model of general practice.

The report claimed that by operating as independent contractors running small, isolated businesses, GPs were restricted in the number of services they were able to provide.

However GPC negotiator Dr Peter Holden disputed claims that practices should move away from being small independent providers. He said: 'Large organisations have a tendency to be impersonal and inflexible. This is about quality of services – practices can federate services.

‘What we can say is that big organisations end up costing more.’

The King's Fund report said that the current delivery model in primary care was based on 'outdated ways of working that result in poor value for money and lack of user responsiveness'.

It said: ‘All of those involved in commissioning and delivering health and social care services must look beyond current models of care to create a delivery system that really is fit for the future.'

It criticised the current separation between GPs and hospital-based specialists, which it said often inhibited ‘the provision of timely and high-quality integrated care to people who need to access a range of services relevant to their needs’.

Dr Holden said that this split was due to the creation of a 'purchaser-provider split'.

'That’s been driven by the purchaser-provider split, there isn't the time any longer to talk to our secondary care colleagues.'

The report also criticised the current model of general practice as a ‘cottage industry’. It said that as independent contractors running small businesses, it was difficult for GPs to ‘extend the scope of the services they deliver and the hours at which these services can be accessed’.

‘Primary care in the United Kingdom is more firmly established than in many other countries and provides a wider range of care than at any time in the evolution of the NHS.

‘Despite this, there is evidence of wide variations in the quality of care and inequities in the distribution of GPs. If the aim is to tackle these variations and to deliver more care out of hospital, the current cottage industry model of general practice is not fit for purpose,' the report said.

It also praised GPs that had formed large practices offering services such as specialist consultations, diagnostic facilities and minor surgery, and minor-injury clinics.  

‘Innovative practices are showing the way by delegating more tasks to nurses and other staff, enabling GPs to focus on diagnosis and urgent needs, and to lead the work of the primary care team.’

‘Larger practices are also able to make use of the specialist expertise of some GPs, thereby reducing the use of hospital services where clinically appropriate.’

According to the report there was also scope for more care to be provided in ‘convenient’ settings such as GP surgeries or nurse-led clinics in supermarkets.

However Dr Holden lambasted this suggestion. He said: ‘It’s the classic 21st century consumerist model. They’re trying to make the case for the Virgins of this world to take over.'

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