GPs drive NHS integration initiatives despite patchy support from commissioners

GPs across the UK are leading innovative schemes to integrate primary and secondary care despite patchy support and funding from local commissioners, the RCGP has said.

Integration: GPs are developing wider range of services in primary care
Integration: GPs are developing wider range of services in primary care

The RCGP's The Future of GP Collaborative Working report praised GPs for working alongside secondary care physicians and other healthcare professionals in designing collaborative services that meet the needs of their local areas and patients.

In Brighton and Hove, a memory assessment service has reduced unnecessary hospital stays in dementia patients by treating them in their homes, the report said. The London-based Connecting Care for Children service manages complex cases in the community through joint clinics between GPs and consultant paediatricians.

However, the RCGP warned that services were effectively dependent on the willingness of local stakeholders to redesign services, and that if this willingness was lost, it could lead to services being ‘let go’ over time. Despite repeated government commitments to integrate health and social care, the college warned that serious concerns remained about funding and staffing shortfalls and whether the NHS could deliver the change needed.

Complex patients

RCGP chairwoman Dr Maureen Baker said: ‘One of the greatest challenges facing the NHS is how to respond to the increasingly complex needs of our patients.

‘Our patients’ health outcomes are best when we treat them as people, not diseases, and this holistic approach can only be achieved when doctors from across the health service work together.

'We will be working with NHS England and others to ensure that good ideas like those highlighted in our report today are adopted more widely, where appropriate, as we implement the GP Forward View.’

Many of the simpler schemes highlighted by the RCGP involved the integration of additional health professionals  into the everyday working life of practices.

Co-location of services

The Old School Surgery in Bristol became the first practice in England to employ a full-time clinical pharmacist and works closely with a co-located pharmacy. The surgery says it has both improved prescribing practice and increased the time available for GPs to offer proactive care.

Thornbrook Surgery in Derbyshire has employed a mental health professional for 10 years and has seen an increase in patient satisfaction, and a reduction in stigma surrounding mental health. This combination has reduced non-attendance rates and referrals to secondary care mental health services.

The RCGP report echoed calls from the House of Commons health select committee for increased collaboration and multidisciplinary working in general practice. In a report last month, the committee - led by former GP Dr Sarah Wollaston - warned the government must provide funding to underpin this shift.

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