The future of registered patient lists in general practice has been guaranteed by the DoH, for at least as long as practice-based commissioning (PBC) lasts.
That was one of the key themes in a debate hosted by the National Association of Primary Care (NAPC) in London last month. Some of the most influential people in the sector gathered to discuss the future of general practice, and how it would look at the completion of the NHS Plan in 2010.
Delegates were concerned that the way primary care is developing could mean an end to patient lists at practice level.
Dr Mo Dewji, a GP and clinical director of primary care contracting for the DoH, said: 'The central question is whether there will be a registered list and what exactly that will be. How can you be an advocate (for patients) without it?'
Chairman of the RCGP Dr Mayur Lakhani argued against the fragmentation of registered lists but asked: 'How do we maximise list-based care to improve care and ensure that it's not a barrier to patients getting good things elsewhere? It would be too big a step to disband the practice list but we can evolve the thinking around it.'
GP Dr Rory McCrea is director of ChilversMcCrea Healthcare, a private company that runs 20 practices around the UK. He said: 'In Australia they do not have a list-based system but a lot of people visit the same GP.
A national administrative body oversees the process and maps trends. So the list function occurs, but not at the practice level. Health outcomes there are better than in the UK.'
However, an adviser to the DoH present at the meeting was adamant about the future of patient lists. 'We see them as a given. That's what we are building PBC around. Since the White Paper, it's not been an issue at the DoH. The only thing that will undermine lists is patients bouncing around GPs because they are not happy with the care they are receiving.'
Former GPC chairman Dr John Chisholm, who, with past GPC colleague Simon Fradd, recently set up private company Concordia Health to run practices, said health systems with strong primary care and access to clinical generalists in a community setting produced better outcomes and were more cost-effective.
'We should not be having a debate about registered lists,' he said. 'The decision has been made - the right one. I would certainly not make registered lists dependent on PBC succeeding. We have had lists since 1913 and PBC for five minutes. But we have made insufficient use of lists for research and delivering population-based care.'
Sarah Harrison is practice manager of a single-handed practice in inner-city Peterborough, employing five salaried GPs to cover 8,000 patients, who, between them, speak more than 50 languages.
She told the meeting that they had developed a thriving practice in a challenging environment through innovation, risk-taking, and giving patients what they wanted: 'The local practice is the future. We have intimate knowledge of our patients' lives and can respond to local needs. Our cross-generational relationships over the long term cannot be measured by performance targets but are essential to good health.'
Dr Lakhani said there would always be 'amazing practices', but general practice needed to be modernised on a wider scale.
'By and large, general practice has been very successful in developing new services, but how do we make that effort more strategic, more concerted?' he said. 'We need a step change in how general practice is managed if we are to take on the strategic planners of the acute sector. How would we do that to meet the needs of our communities? We must raise our game.'
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