NHS reforms must help overworked GPs improve preventive care

The NHS must do more to allow overstretched GPs to improve preventive care, NHS England's clinical director for cardiovascular disease prevention has said.

Speaking on the need for GPs to ‘get serious about prevention’ at the RCGP annual conference in Harrogate, Dr Matt Kearney emphasised that GPs need to find ways to work differently in order to work more effectively.

It is clear that GPs have ‘no capacity to do more’ than they currently are now, Dr Kearney said. However, he said that GPs can make three major changes to help tackle the main behavioural and clinical factors driving morbidity and mortality rates.

The first is population-level interventions, where STPs will offer opportunities for GPs to take a leadership role in planning wider care outside of general practice, Dr Kearney said.

The second is to support behavioural change in individual patients. Over 1m GP consultations take place a day, offering plenty of opportunities for GPs to ‘advise on lifestyle risk factors’.

The third is clinical preventions, where there is ‘opportunity for improvement’, Dr Kearney said. High BP contributes to half of all strokes and heart attacks, AF is associated with a five-fold increased risk of strokes and high cholesterol is linked to a progressive increase in risk of stroke and heart attack.

Treating these factors can drastically reduce these risks, but is not widespread. Currently, only 60% of patients with hypertension are being treated to the ideal level, just one in three AF patients are being given anticoagulants and one in two with high cholesterol are treated with statins, Dr Kearney said.

‘Clearly a lot of improvements can be made by improving this,’ he said. ‘If everybody eligible for anticoagulants got them, 10,000 strokes could be saved a year.’

Prevention can reduce demand

But he went on to add: ‘That’s all very well, but need to think in real world. We’re very overworked and don't have capacity to do this - it is trumped by other priorities.

‘So I don't think we're going to improve care by working harder - it can only be done by making the system work better for us and patients.

‘There’s a real opportunity for us in prevention to reduce demand and improve care. I think our starting point has to be recognise this is an existential threat.

‘Second of all we have to acknowledge our capacity to do more. We should grab the opportunity that comes from the Five Year Forward View.

‘It is worth us working as a priority to get better at secondary prevention - we can stop a lot of heart attacks and strokes in a relatively short time.’

He added: ’We should consciously rise to prevention challenge. We should challenge ourselves as GPs and nurses to lead the conversation about prevention in the NHS and ensure the solutions reflect the world in general practice.

‘We need to challenge the primary care system to find more ways of treating these high risk conditions, because it will reduce disability, mortality - and it will help reduce our burden.’

Full coverage from the RCGP annual conference

Photo: Pete Hill

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