The publication of the Francis report into Mid Staffordshire NHS Foundation Trust underlines what many healthcare professionals have known for a while - the NHS is in peril. Over successive governments, too much top-down, target-driven, management has battered and fragmented our beloved NHS- at the cost of patient care.
GPs have weathered this storm. In times of adversity we have shown that high standards in general practice prevail. We continue to provide undifferentiated care to patients, their families and carers across physical, psychological, and social domains. We need to retain this and celebrate the good services we provide - which, I strongly believe, are still among the best in the world.
As always, there is room for improvement - changing the way that practices are structured is one way to both reclaim continuity of care and integrate our services to enhance the patient experience. Federations of practices allow GPs to tailor our services to suit the needs of a particular community and help to keep the NHS- and patient care - safe, fair and amazing value for money.
Continuity is one of the cornerstones of primary care across the UK. One of the recommendations in the Francis report is for GPs to have an obligation to their patients once they have been referred. I agree - and I also know of a good many GPs who are already doing this. The precious relationship between a GP and patient, built over time, needs to be cherished, not fragmented.
Federations can work together to pool resources - and knowledge - and enhance the care we provide to our patients. Patients' needs are becoming more complex and federations offer the availability of increased and more specialist services, increasing continuity. Federations also offer much-needed peer support. I myself work in a federated practice - albeit under a single organisation - but the organisation works for patient care and, I hope, for the staff that we employ. However, there are many models and the solution is to find what works best for your local area and local GPs.
I’m sure you all remember the tragic helicopter crash in Vauxhall recently. My practice was evacuated and, because it is part of a federation, all staff and patients were swiftly relocated to a partner practice nearby, ensuring that disruption to patient care in the most awful of circumstances was minimal.
Federations will also facilitate greater integration of care - essential as GPs see their roles extending to public health, education and prevention. Integration is good for patients. Look at the Bromley-by-Bow Centre in east London - in the overriding negative aftermath of Francis, this surgery was singled out by the Guardian as providing exceptional care to patients. Why? Because, as the article said, the centre is like John Lewis. You go in for one thing, maybe a cough or a cold, and you can be advised about a housing issue, improve your English or have a coffee and socialise- all things that are beneficial to patients’ health in the long run and which demonstrate true continuity and integration in action.
As GPs, we need to celebrate our successes; ensure we retain what works, and be adaptable enough to make changes, where necessary, to meet new challenges as they arise. Federations are an excellent way of achieving this.
* Professor Clare Gerada is RCGP chairwoman and a GP in south London.