The RCGP's vision for primary care

The college's road map for the future sees the grouping of practices as the right route. Colin Cooper reports.

The major organisational development in the RCGP's vision of the future is the grouping of practices into federations.

There is no definitive size or shape, and no particular route offered for practices to drive down. The emphasis is on organic change, led by GPs, towards a form of collaboration that suits the local conditions.

The college's road map document, 'The Future Direction of General Practice', foresees primary care delivering a more comprehensive range of services in the community.

It states: 'We suggest that virtually all health problems in the population - including mental health - could be dealt with in primary care, with short-term referral as needed.'

This will require expanded, but better integrated primary care teams with enhanced access to diagnostics. The individual practice unit will remain the building block, but practices will need to group together to meet demand and offer more services.

Variety of models
The groups could range from informal co-operation to formal legal entities, led by GPs with a key role in raising standards, improving services and supporting practices.

RCGP chairman Professor Mayur Lakhani said that gradually the federations would take over many of the tasks currently undertaken by primary care organisations.

'Federations will start in a soft way, working together, but as they demonstrate their worth they should be allowed increasing autonomy. PCOs will have to let go and deal mainly with areas such as high-level strategy, governance and commissioning.'

While the college says that co-location of services will be necessary to create this new model of care, there will be a fundamental difference to the polyclinics recently proposed for London.

The road map warns: 'We caution against the development of super-surgeries or disease-focused polyclinics, which simply co-locate individuals without an underpinning philosophy.

'Whichever models are adopted, the values of general practice, such as interpersonal care and continuity of care for defined populations and registered lists, must prevail.'

Alongside the reorganisation of practices into federations, the college also believes that primary care needs to become more strategic in its approach to meeting the needs of patients.

'Leadership from GPs will be essential. This will require innovative and creative ways of working, including business models to develop new services, raising capital and utilising economies of scale,' states the document.

The result of all this co-operation should be a more co-ordinated approach throughout the health and social care system, with GPs playing a crucial role in preventing breakdowns at the interfaces between the different sectors.

'We believe that this is important to stop the worrying trend of fragmentation of care and to define for patients who is accountable for specific problems,' the RCGP said.

GPs train consultants

The vision of the future will require extra staff, new and improved premises, and a much stronger emphasis on education and training.

Hospital consultants could even be trained in practices.

'Why do you need to learn to be a doctor in a hospital, when 90 per cent of the care takes place in the community?' Professor Lakhani commented.

What will be the role of the individual GP, who does not want to be a high-flying manager leading a federation in to the future?

Clinical professionalism and 'personal doctoring' are at the heart of the college's vision, with a key aim being the improvement of the quality of the doctor-patient relationship.

And what of those who say the vision will never materialise? Well, the college is putting its faith in the 'potential and power of practices working together', and wants to see 'a movement' developing, a 'force for good'.

It gives the potent example of out-of-hours co-operatives. In 1988 there were some 500 GPs in co-operatives but just 10 years later there were 22,000. Perhaps it's time to fasten your seat belts.

Case study
Personal care and innovation

The GP Care Limited Liability Partnership is an innovative, flexible and inclusive organisation based around general practices in Avon. Formed from a concept developed by local GP Dr Simon Bradley, the group involves experienced members of the NHS community delivering quality family healthcare through a distributed network of local healthcare providers and premises.

The organisation builds on the best of traditional general practice at the same time as innovating and extending the range and quality of healthcare available close to patients' homes. More information at

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