If I were in charge… Rule No.1
I thought I would spend some time reflecting on what changes I would make if I were in charge.
Just complaining about the system could start to wear people down.
I think there are some fundamental principles that need to be embraced in primary care. Some of these are already being achieved and some of these are pure aspirations, some are being eroded and are now in serious danger of falling off the edge.
Here are my first thoughts:
Rule 1. Every person in the UK is entitled to care from a named GP.
This seems simple but in practice it is easily eroded. What is indisputable is that people value continuity. They may also need to access Walk-in Centres and NHS Direct but when you have any kind of illness that can’t be resolved completely in a single contact then it is stark-staringly obvious that it helps to see the same GP again.
Pulse reported on this in the past month. There is something of a paradox here in this survey but extending hours doesn’t tend to do much for continuity when the evening/weekend clinics are share out. The ideal continuity of care would mean you could access the same GP 24 hours a day 7 days a week. This is clearly not likely to result in a very happy and effective GP workforce. We tried it in the past and it ended up with a singular lack of GPs. I have been that GP and it is Officially Miserable.
I think the named GP should work a certain minimum number of sessions to be eligible to be a ‘named GP’ and be reasonably accessible to the patient. I don’t think that person has to be a principal and they could easily be salaried (but see Rule 3). I don’t have a huge problem with the accessibility being measured in some way. However, previous methods of measuring accessibility to GP appointments have, if anything, damaged continuity of care as practices have offered same-day appointment systems and other dubious innovations to ensure access targets are met.
There should be special protection under this rule for the housebound, elderly, disabled and residents of nursing homes etc. It might even be worth measuring continuity in this group of patients. How many different GPs have they seen in the past 12 months? I would wager that quality of care is inversely proportional to that number. One large practice near us has a ‘duty doctor’ who will do visits on their designated day for the whole practice. In a practice of nearly 20 GPs it can be a while before you see the same GP again…
That named GP should be actively involved – not just the ‘registered GP’ so often quoted that has never met the patient.
So it is simple: one patient, one genuinely responsible GP.
Trackbacks