Who is to lead the large strategic changes to general practice that are required to deliver 21st century health services that can respond to the increasing health needs of the population?
In his editorial Chris Drinkwater proposes that we should re-think the provision of primary care in the light of the needs of our 21st century population. Certainly a strategic plan is required. General practice has been allowed to ‘evolve’ without any clear vision over the last 50 years. It has migrated from being a service that mainly responded to the presenting needs of patients to one driven by QOF. Now a third strand is emerging around co-productive care planning for long-term conditions and older people.
Over the same period other community services have hardly changed, links with primary care teams have been undermined as they have oscillated from one corporate managerial home to another, and organisational and professional interests have undermined the systematic integration of services.
Bearing in mind that GPs have moved from having one job (reactive care for a registered list) to two jobs (reactive and now proactive care with QOF targets) and are likely to be vested with a third (care planning) it is no wonder that GPs feel overwhelmed. Over the same period there have been additional demands as a consequence of clinical workload that has ‘moved from secondary to primary care’, and additional organisational workload including supporting CCGs.
There is adequate evidence to make the systematic implementation of targeted, multidisciplinary care planning for long-term conditions desirable. Surely this must be led by general practice, with its long-term knowledge and relationship with patients, practice lists and disease registers. However if this new service model is to be established, we will need horizontal integration of general practice with community services, including social care. This will require investment, and the rationalisation of reactive care, including out of hours, at local level using whole systems approaches.
So who is to lead these changes? Drinkwater suggests a ‘Chief GP’. I believe that it is unlikely that the substantial changes required can be led from within the bureaucracy of government. Even if they could, the credibility and acceptability of ‘managerially’ led change is now long past. Surely now is the time for the RCGP and the BMA to take concerted action to effect change as they did in the 50s and 60s. Now, as then, there is a need for action driven by energetic colleagues from the front line, who are supported by professional bodies with a wide understanding of the issues. However this time we must also engage and enlist the voice of the patients who we serve. They are our strongest allies. The co-production of the new service model jointly with our patients will ensure that we remain focused and not blown off course by political or professional vested interests.
- © British Journal of General Practice 2013
