Put continuity of care ahead of the 'McGP'

This column recently asked if we would recognise primary care in five years' time.

Little did we know when this question was published, and this week's 'General Practice in Flux' special report was planned, just how fast primary care was changing.

As radical plans for reform emerge from SHAs and PCTs, it is becoming hard to visualise the future NHS landscape and especially for general practice, which could see an expansion of the traditional practice or its total obliteration depending on whose report you read.

The most striking reimagining of primary care has emerged from Heart of Birmingham PCT this week. It has devised a plan to replace its 76 practices with 'franchises' to run 24 'primary care units'.

Each franchise will 'deliver services' to standards set out in a 'service specification manual' which will prevent 'variation and inconsistencies'.

This tearing up of everything we know about general practice could be seen as the arrival of the 'McGP' or the advent of super-PMS, bigger better practice contracts that bring premises and service investment.

However, reading the Heart of Birmingham report it does seem to incline towards the McGP concept. There is much mention of how multinationals such as Virgin or Tesco would offer flexibility and the ability to enter a market in weeks rather than years - ignoring the fact that they have no experience in recruiting health professionals or delivering primary care.

It also talks of the franchised units producing 'better trained employees from a customer care point of view'. The problem here is what is meant by customer care; it is unlikely to be the same as continuity of care. Indeed, in some parts of the proposal the phrase 'patient throughput' would not seem out of place.

There is no denying that inner-city areas such as Heart of Birmingham need investment in primary care facilities and are at risk of a retirement explosion. There might be a strong argument for new types of practice, especially as attitudes to partnerships change and the government pursues its policy of moving more care into the community.

However, any plan must recognise that healthcare cannot be delivered in the same way as burgers or pizza. The 'customers' want the continuity of care they value from their current providers and want tailored, individual solutions, not 'one size fits all' because it says it in the medicine manual.

Heart of Birmingham might see GPs as preferred providers in its plan, but it must go further in considering patients and actual care if its radical reimagining is to deliver an acceptable solution.


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