The role of GPs is changing rapidly, and so is that of their practices. GPs must deliver more services to more people than ever before by extending the provision and commissioning of care. Faced with delivering new services in too many inadequate primary care buildings, this task could not have come at a more challenging time.
So what is the answer?
Nobody is expecting GPs to develop specialist expertise. However, in a more integrated health service, this means being part of a multi-disciplinary team that is still based at where over 80% of all first patient contacts in the NHS occur – in the general practice.
Extending the service and facilities to provide a greater range of care outside hospitals is consistent with the aims of the Health and Social Care Act 2012.
PCTs in England often did not fully understand list-based practice, which resulted in fragmented primary care, and the creation of single community specialty teams, or services. These were thought to be multi-disciplinary, but only focused on one condition or specialist area rather than the more holistic approach of general practice.
Access to the NHS remains via registration with a GP practice. But patients are being offered more choice so will expect more from their practice.
Primary care team expansion
GPs need to be more ambitious in the delivery of care to their registered population. General practice will also be expected to complete more episodes of care from the 250 million contacts currently thought to occur annually in general practice in England.
This means expanding primary care teams beyond practice nursing and administrative support. Patients with complex long-term conditions require the right skill mix of nursing, allied healthcare professionals, diagnostics and social care. GPs also need to develop their role as clinical commissioners, particularly at the point of referral.
Many practices that have gone down the premises leasing route, with property developers and investors upgrading and expanding or build new medical centres, already have co-located pharmacies, but these must become centres of clinical expertise rather than simple dispensaries.
Health and social care campus
Joining up with dentists and optometrists, and improving IT infrastructure, will help to develop the practice into a health and social care campus capable of delivering far more complete episodes of care at one venue. This is what we believe has been achieved for [Dr Kingsland's practice] the St Hilary Group Practice’s new premises (pictured) in Wallasey, Merseyside and which Assura Group funded.
By working in a way that facilitates more ‘right care’ with patients accessing the appropriate health or social care professional at first contact, GPs can create the headroom to treat patients with more complex conditions that require the expertise of a community physician. It will also allow more patients, particularly those with long-term conditions, to be reviewed and have confidence in their primary care team.
A large proportion of primary care estate is unfit for GPs to deliver wider-service provision, and, despite their best intentions, some practices, especially smaller ones will struggle to comply with the Care Quality Commission's standards – let alone to house the high quality, varied services they are expected to provide.
Delivering small, isolated services in converted premises may no longer be adequate. IT infrastructure, diagnostic equipment and growing teams must be accommodated, requiring a huge cultural change for the NHS Commissioning Board and clinical commissioning groups to address.
The goal should not be to build huge ‘mini hospital’ health centres - it is important to maintain the feel of a generalist service - but we must build in space for more healthcare professionals.
With the recently opened medical centre for the St Hilary Group Practice, we have created a building that ‘works’ and is able to house ultrasound, physiotherapy and other simple diagnostics, an Age UK service, the Citizens’ Advice Bureau, return to work advisers, a counselling team and a library service.
This epitomises the 'Big Society' idea, and moving primary care upstream in this way will naturally require infrastructure investment. However, much of this may be achieved by redeploying resources effectively or partnering with private sector investors and developers.
- Merseyside GP Dr Kingsland is the national clinical commissioning lead for England and Graham Roberts is medical property investors Assura Group's chief executive officer.