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A PCN Managers Perspective on The Future of General Practice - House of Commons Committee Report
Updated: Dec 20, 2022
As always, I write my blogs for new Primary Care Network Managers, Administrators, Clinical Directors and those with an interest in PCNs.
On 20th October 2022, the House of Commons Health and Social Care Committee released its report on the future of general practice health and social care in England. The 61-page report makes 41 recommendations for improving the delivery of healthcare services to patients covering:
Access
Continuity of care
Integrated care systems
Primary Care Networks
Organisational support
The GP Partnership model
Premises
General practice incentives
Recruitment and retention
Organisational development
Through reading the report, three areas relating to access, continuity of information and management and navigating the growing number of healthcare professionals and organisations struck me as areas that, at a local level, we could influence, improve and inform as we move forward.
Let's jump in.
Access
Every working day more than one million people attend an appointment at their local GP surgery, and 90% of healthcare is delivered by Primary Care.
The estimated total number of appointments in general practice in England in June 2019 was 23,800,000 - by June 2022, this had risen to 25,910,000, an 8.9% increase without including covid-19 vaccination appointments.
In May 2022, there was an estimated 27.5 million appointments in general practice, more than two million more than in 2019. In the same period, the number of qualified, full-time equivalent GPs working in the NHS has declined by nearly 500 from 28,094 to 27,627.
In August 2022, 23.2% of doctors in general practice worked full-time, and in 2021 58.4% worked three days a week or less.
The government is not on track to recruit the 6,000 additional GPs target.
The locum workforce is growing, which favours a greater work-life balance and flexibility.
An RCGP survey of GPs and GP trainees found that 42% of respondents were likely to leave general practice in the next five years.
Workloads are unmanageable and unsustainable.
The interface between primary and secondary care is in urgent need of attention.
The impact of this mismatch between demand and capacity in general practice is that patients are experiencing poorer access to general practice, and the workforce is in crisis.
Whilst the intervention of enhanced access is seeing Primary Care Networks from 1st October 2022 required to offer patient appointments between 6:30 pm and 8:00 pm Mondays to Fridays and between 9:00 am and 5:00 pm on Saturdays is an acknowledgement that more access is being delivered.
The growing PCN workforce in the form of the additional role reimbursement scheme (ARRS) is again an acknowledgement of the workforce crises, which is providing funding for 26,000 additional roles to create bespoke multi-disciplinary teams. But the experience of its success is variable, with staff not fully integrated into the network and reports of lack of supervision.
It's worth noting, that recruitment, retention, supervision, workload management, the press, an increasing population, health inequalities, and the wider determinants all have an impact on access.
🎯 As a primary care network leader at a local level, are there any improvements your team can facilitate relating to access?
Continuity of Care
Continuity of care is the ongoing relationship between a GP and their patients over time and is considered one of the defining features of general practice.
The GP's individual list of patients for whom they are accountable and deliver the majority of their care is considered the gold standard of continuity. However, the paper highlights that the number of practices using this system, which is not routinely measured, is estimated to be fewer than 10% of practices.
Barriers to individual patient list sizes are widely reported in the form of; not enough GPs, an ageing population, multi-morbidities and increasing demand.
The report recognised that continuity of care is valued differently by different patients, differs from area to area, and there is often a trade-off between continuity and the speed of access.
Importantly, continuity of care does not only come in the form of the same healthcare professional.
Continuity also extends to the continuity of information across patient records and the information we receive as patients from health providers and management continuity with colleagues.
New Healthcare Structures
We, of course, have Primary Care Networks. Please see the video below.
A further introduction to Primary Care Networks can be found here.
The Health and Care Act 2022 has recently brought major changes to the NHS in England in the form of 42 Integrated Care Systems, which are responsible for improving the health of their population. Our guide to integrated care systems can be found here.
We also have the recommendations of the Fuller Report coming into play which create further teams to navigate around.
The report highlighted this evolving landscape is challenging to navigate for patients and in my experience, is also challenging as someone who works in the system and is trying to keep up to date with who does what.
🎯 As a Primary Care Network leader at a local level, when it comes to access, continuity of information and management and navigating the growing number of healthcare professionals and organisations, are there any ideas you could influence and improve in your Primary Care Network?
Recommended listening
I'd like to share with you a recently released podcast episode with Dr Richard Fieldhouse, who is a GP Locum, Chairman & Founder of The National Association of Sessional GPs.
We have a great discussion on the current demands on GPs at the moment and how Locum GPs are providing a valuable service to their patients.
About the Author
I'm Tara, I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast.
I have over 20 years of project management and business development experience across the private and public sectors.
I have managed teams across multiple sites and countries, I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care and I'm the author of over 200 blogs.
I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.
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