It is well recognised that continuity of care and the unique relationship between the GP and their patient are two of the great strengths of our NHS.
General practice holding a registered list and having the ability to deliver care to a defined population is the cornerstone of our NHS. The GP acting as an advocate of the individual and offering holistic care is very important both for their patient and the public.
One of the challenges facing the NHS in terms of patient care is the lack of close working relationships between general practice, community services, social care and hospital based care. This often leads to fragmentation of care, duplication, inefficiencies and, all too often, the default position is 'see your GP'.
As 90% of patient contacts occur in general practice, a community-based model that does not build on the registered list will have limited impact.
The multispecialty community provider vanguards (MCPs) have been formed by a loose partnership between general practice, community services, social care and, often, the voluntary sector and acute providers.
A natural progression is to move to a population-based budget with outcome measures based on population health and this is exactly what we are exploring where I practice in Southern Hampshire. This would give greater flexibility for providers to decide the most effective way to organise services in the natural community of care, based on the defined needs of their local population.
New MCP contract
The new MCP emerging care model and contract framework is evolving based on work undertaken in the new care models programme vanguard areas. For this to be effective, it is essential that there is good local leadership, clinical engagement, trust and strong relationships. With general practice at the centre of this, the ability to shape, influence and drive the change that is needed will be significant.
As part of a whole population budget the MCP could hold a budget for community nursing and therapy. For instance, this can provide the flexibility to really transform the way services are delivered and allow integration with general practice and the scope for greater improvements to be made.
The proposals for how the new emerging voluntary contract may work, could also include urgent care, frailty services, learning disabilities, some outpatient services (such as diabetes) and provision of enhanced services to care homes with the potential for better services that meet the defined needs of a population.
In the Better Local Care (Southern Hampshire) vanguard where I work, we have created a ‘Same-Day Access Service’, which pools together the urgent workload for the participating GP practices. In its first six weeks, the service handled 5,500 patients – almost two thirds of whom had their needs met over the telephone. This initiative has contributed to halving waits for routine GP appointments.
Tackling growing GP workload
We know that practices are under enormous pressure. The MCP and new models of care are one way to help hand back some control to practices, stopping the growth of hospital based care at the expense of primary and community care.
It could also remove existing barriers between general practice and community teams as sharing a common record would mean that care is centred on the patient rather than the organisation and allow patients to be seen by the right member of the team.
It has been shown that 10% of care provided by GPs and community staff is duplicated and about 30% of patients seen by a GP could be seen and managed by a member of the community team.
This is a major opportunity for general practice to have significant influence on the design and delivery of community based model of care, which should reduce fragmentation, duplication and remove existing barriers to provide better care for their patients. It will also ensure services support and enhance general practice.
As a GP, I know there are inevitably risks in entering into a contract that has not been tested with a budget that is set on data that may not be complete but I can’t ignore the potential benefits. This is why it is essential that safeguards have been built in for practices to retain their GMS or PMS contract if they wish and ensure that their funding is not put at risk.
Some practices may want to explore an employed model where the legal entity that holds the voluntary MCP contract is able to employ the staff and GPs in the practice, hold the lease or own the premises and offer indemnity, and reduce the requirements in terms of CQC inspections.
Many of my fellow GPs tell me that the biggest challenge they face is workload and one of the factors that would make general practice a great place to work again would be to regain some control of their working day. My hope is that with the skill, dedication, hard work and innovation that exists that the creation of these opportunities with the greater flexibility on offer will allow general practice to realise these ambitions.
- Dr Nigel Watson MBBS FRCGP is a GP in Hampshire, chair of the New Forest MCP and joint CEO of Hampshire MCP and chief executive of Wessex LMCs
- This article first appeared on NHS England's website.
Picture: Pete Hill