Viewpoint: The King's Fund on how general practice should change

There is much to celebrate about today's general practice, writes Dr Anna Dixon. Significant improvements have been made in managing chronic illness over the past decade and the majority of patients report a good experience of care.

Dr Anna Dixon: 'We make no apology for saying change is needed.'

Internationally, there is evidence that strong primary care is essential to a high performing health system. However, pressures are growing and looking to the future, changes in the population, the burden of disease and technology mean that GPs, along with other health and social care providers, will need to work in different ways.

We make no apology for saying change is needed. The RCGP recently ran its own consultation on the future of general practice which also recognised the need to develop new models of primary care to meet changing health needs.

If general practice is to rise to this challenge, among other things it needs to:

  • work with a wider range of health and social care professionals to deliver more integrated care for patients with complex health and social care needs
  • work with hospitals and community service providers to develop models of shared care that ensure timely and appropriate access to urgent care for patients 24/7
  • be more proactive in reaching out to high-risk groups and working with local authorities to promote health and prevent disease.

Some practices are already leading the way.

Whitstable Medical Practice in Kent has developed in-house diagnostics, day-surgery, and specialist clinics, delivered by a combination of GPs and outreach consultants. This enables patients to access these services closer to where they live, and helps GPs to work closely with hospital specialists to deliver integrated care. 

In Birmingham, seven general practices have merged to form Vitality Partnership, a super-partnership with a list size of 51,000. The economies of scale have enabled the partnership to deliver a range of specialist services, and it has plans to develop dentistry, pharmacy and community nursing services.

And in Hammersmith and Fulham, south-west London, QOF+, an innovative pay-for performance scheme, rewards practices for achieving locally determined quality indicators, based on data on practice performance from electronic patient records.

These examples showcase general practice at its best - proactive, innovative and in tune with the needs of patients. However, this is not the case everywhere. This week The King’s Fund is publishing an analysis of general practice in London. Commissioned by NHS London, the report highlights significant variation in the quality of care between practices and areas ­- a finding consistent with our independent inquiry into general practice in England, published last year.

While this variation is partly explained by the diverse populations covered by some practices, encouragingly, some are bucking the trend by delivering outstanding results, despite serving very deprived communities. In Tower Hamlets, east London, for example, practices have been working together in clusters for several years, systematically using data to tackle variations with a specific focus on improving control of diabetes and uptake of childhood immunisations.

General practice in London faces some specific challenges - some parts of the capital have relatively few GPs per head of population, the ratio of practice staff to GPs is lower than in other parts of England, one in five practices are single-handed, and many GPs will be retiring in the next five years. By working together, general practices will find it easier to rise to these challenges.

Clinical commissioning groups need to engage their member practices in understanding these variations and identifying priorities for improvement. A wealth of data is available which, if presented in accessible ways, can shed light on the health needs of local population groups and the priorities that need to be tackled. Data can also help to identify high performing practices from which others can learn, as well as those that need extra support to improve.

We hope GPs will engage in a debate about how general practice can rise to the challenges of the future and ensure the best possible care is consistently available to patients everywhere.

* Dr Anna Dixon is director of policy at The King's Fund.

* GPs rebuff calls for major changes to general practice in London

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