GPs can expect to see a major shift in their work over the next five years, as the demands of practice-based commissioning (PBC) take them away from the consulting room towards a more public-health oriented role.
This was a key theme at a debate hosted in London this month by the National Association of Primary Care. Some of the most influential people in primary care discussed the future of general practice, and how it would look at the completion of the NHS plan in 2010.
RCGP chairman Dr Mayur Lakhani told the meeting that there was a range of challenges ahead for GPs. 'We have to work out how we can have a leadership role in the NHS.
'We need a stronger general practice with a strategic role, a role in acute medicine and diagnostics, and we need to see practices working together.'
Dr Lakhani argued that the profession needed to define a set of values by which to develop future services: 'We need to establish our values otherwise they will be the first thing to go.' His suggestions included relationship-based care, quality improvement, patient involvement and co-ordinated services.
Dr Steve Feast, senior policy adviser in public health at the DoH, praised the quality of services offered by GPs, but said they needed to broaden their reach within communities.
'We offer good services to people who come through our doors but what about the others?' Those who fell through the net would miss out on the preventive care and advice they needed, he said, and could require more expensive secondary care later on.
A move to a population-based model of care was seen as inevitable by many of the representatives. The DoH's national clinical director for primary care Dr David Colin Thome said: 'I think we GPs could have much more control of our destiny if we had the public on board. Perhaps we need to do the extra work with our populations rather than concentrating on the one-to-one care'.
Dr John Chisholm led the negotiations on the new GMS contract as former chairman of the GPC. His new company, Concordia Health, recently won a contract to run two practices in south London.
Dr Chisholm said the new DoH agenda would expect a more rounded approach. 'We have been very good at one-to-one care, as advocates for patients, but less good at serving our population and addressing inequalities. PBC is our opportunity to get better at that.'
NAPC president Dr Peter Smith was more definite: 'If we are going to have an NHS in future there is going to have to be more change. Practices are going to have to work together with the local population, especially on PBC, to make sure that services meet needs.'
But chief executive of Reading PCT Janet Fitzgerald was not sure whether practices would rise to the challenge.
'We can effectively combine the roles of commissioner and provider, and discharge them in the right way. But we need practices to say they are up for taking on public health needs,' she said.
Dr Colin Thome indicated that a more sensitive approach was required: 'Do we expect too much? I know a lot of GPs who are very good at one-to-one care but could not organise a party in a brewery. Why do we load things onto every practice? PBC is about taking responsibility for a population. It is a chance for generalists to lead but it will not be right for all practices.'
Dr Chisholm agreed: 'There is a range of skills in the medical and other healthcare professions and a lot of doctors just want to be clinicians. But we desperately need doctors who will bring other skills, particularly the ability to think strategically. We have to devise new models of care that accommodate the increasing numbers of doctors who want to stick to clinical care.'
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FACING THE FUTURE
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