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Picturing the future of general practice

Is your vision of primary care a fragmented Pollock or more akin to Bosch's vision of Hell?

Dr Richard Smith, chief executive of Unitedhealth Europe and former editor of the BMJ, introduced four 'plausible scenarios' of general practice to launch the NAPC summit.

Each looked in to the future by between five and 10 years, but Dr Smith said none reflected his personal views on what could happen - or what he would like to happen. They were simply 'aids to thinking'.

SCENARIO 1

Myriad and fragmented forms of primary care

Dr Smith referred to this scenario as a 'Jackson Pollock'. There are multiple forms of primary care with no registered patient lists. Traditional general practice exists alongside walk-in centres, online services, private companies, voluntary organisations and pharmacies, with immediate access to specialists.

People use different providers for different problems at different times. There is loose regulation, lots of advertising, innovation and competition.

SCENARIO 2

Generalists run the world

A highly developed form of general practice, with large practices commissioning in groups for all health services, plus social services and housing. Budgets are huge, professional managers run the system, and most doctors are employees working to strict protocols. There is a heavy emphasis on public health and IT.

SCENARIO 3

The end of general practice

In this 'Heironymous Bosch' vision of the future, there are no generalists. Patients access specialists directly in the community, whether they work in chambers or are employed by foundation trusts. Specialists lead extensive teams, supervising the care of long-term conditions via nurses. Minor illness services are available online, by telephone and through nurses and physician assistants, who may triage to specialist doctors. Out-of-hours care is provided by emergency practitioners.

SCENARIO 4

High-tech general practice

GPs offer a wide range of services, supported by diagnostic and decision-support technology. Patients begin their interaction with doctors through IT, which takes a history and makes a provisional diagnosis, and the GP will often treat without the need for specialist referral. Human issues are left to priests, counsellors and hairdressers.

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