RCGP urges continuity of care rethink

Named teams of GPs should be responsible for patients seven days a week to restore continuity of care destroyed by the 2004 GMS contract, an RCGP commission has found.

Dr Clare Gerada: 'The commission is one of the most important pieces of work the college has ever been involved in' (Photograph: A Deverill)

The independent commission on generalism, set up by the RCGP and the Health Foundation charity, warned that continuity of care was 'widely seen as having been undermined by the 2004 GP contract'.

Chaired by crossbench peer Baroness Finlay of Llandaff, it was set up to explore the issues facing medical generalism.

A report by the commission accepted that a return to named GPs was unworkable. But it called for 'steps to restore a discipline of continuity of responsibility for registered patients, seven days a week'.

It also criticised the QOF, describing it as a 'straitjacket' on general practice that focused too much on process rather than patient outcomes. The commission called for GP training to be extended from three to five years and to become more specialised in paediatric care, mental health and end-of-life care.

The commission called on GPs to make use of modern technology to improve contact with patients. It also called for the case for 'a dedicated generalist healthcare service for care homes' to be examined.

  • Named teams of GPs should be responsible for patients 24/7.
  • GP training extended to five years.
  • More use of technology.
  • New GP role in care homes.
Source: Commission on generalism

RCGP chairwoman Dr Clare Gerada has called the commission 'one of the most important pieces of work that the college has ever been involved in' and RCGP members will now be consulted on the findings.

The report found that general practice was now limited by a 'nine-to-five, Monday-to-Friday approach', and warned that patients had 'lost confidence' in evening and weekend services since GPs opted out of out-of-hours work.

In evidence to the commission, Professor John Howie, emeritus professor of general practice at the University of Edinburgh, said: 'Unless generalists have a serious think about going back to a model of comprehensive and continuous care that was the hallmark of the early definition, they are at serious risk of losing their standing and their ability to provide their patients with what they want.'

Northumberland LMC secretary Dr Jane Lothian agreed that the current structure of general practice needed rethinking. 'People's illnesses don't fit into nine-to-five and with an increasingly mobile population we need to look at the service we provide,' she said.

But Dr Lothian said the old model of general practice based around individual patient lists was 'economically inefficient'.

Dr Paul Roblin, chief executive of Berks, Bucks and Oxon LMC, said that in an 'ideal world' GPs would be able to offer fully comprehensive care both inand out-of-hours, but it was simply too expensive. 'Fully comprehensive care is almost impossible,' he said.

GPC negotiator Dr Chaand Nagpaul said the loss of continuity of care could be attributed to poor PCT commissioning rather than the new contract.

'Splitting inand out-of-hours care has had an impact but it is far less than the impact of failings of PCTs,' he said. 'The old contract was unsustainable and doctors were not entering general practice because of the out-of-hours commitment.'

The RCGP's final response is due next year.

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