Support Your Surgery Campaign
The Support Your Surgery campaign
has been launched nationally and locally this week. The campaign
aims to inform patients and the public how government plans to
change the way in which GP services are provided will put at risk
the comprehensive, high quality patient care that their local GP
practice provides.
Two core themes of the campaign are the introduction of more
commercial companies to provide general practice, and the
introduction of polyclinics regardless of need.
The centrepiece of the Support Your Surgery Campaign is a petition submitted in the form of a NHS General Practice 60th Birthday Card. Each and every practice is collecting signatures over the next 10 days and then the Birthday Card will be delivered to the Prime Minister on the 12th June 2008.
More information is available at: www.supportyoursurgery.org.uk
The Government are introducing 250 new surgeries in the next 12 months in England. Some will be new surgeries in under-doctored areas, (there are no such new surgeries planned in Wessex) and there will also be a new GP-Led Health Centre in every single Primary Care Trust (PCT), whether they are needed or wanted. The tendering process for these new GP-Led Health Centres is already underway.
The new GP-Led Health Centres cannot be provided by existing practices or under the same contract that GP practices work under so many commercial companies are bidding to provide these Centres.
These are national solutions to problems that largely do not exist locally but they will potentially divert money from existing general practice services.
It must be made clear that locally the LMC works constructively with all PCTs who are generally very supportive of existing general practice. There is little evidence that these new GP-Led Health Centres are needed locally and the LMC has worked with all PCTs to try to ensure that, where these new Centres are established, they provide additional services in the community and do not damage local general practice services.
Unfortunately this is just one of a number of policies being introduced by the Department of Health which could potentially threaten every practice in the UK.
Background
In 2002/3 general practice was facing a crisis. Funding has been falling behind many other areas and it was becoming increasingly difficult to recruit new doctors into general practice and many older GPs were retiring early. Practice funding was largely related to the total number of registered patients and had very little to do with the quality of care provided by the practice.
Following 18 months of negotiations, a new contract for general practice was introduced in 2004. This delivered increased funding that rewarded quality and provided better conditions for newly qualified doctors. The result has been a resurgence in the popularity of general practice as a profession and reversed the decline of entrants.
Unfortunately, for the last 3 years, the Government has awarded general practice no increase in funding. Inflation and increased expenditure over the same period has resulted in falling resources in most practices. Many of the gains achieved in 2004 are slowly but surely being eroded/taken away.
“By international standards general practice in England is efficient and of high quality. Indeed many countries view with envy our system of list based general practice.”
Words from the Secretary of State for Health in a Government White Paper recently
So, it is somewhat strange that general practice has suffered a sustained attack over the last 2 years from the national media and some politicians, (both of whom can only dream of the level of satisfaction that GPs experience).
General Practice faces an uncertain future, one could be forgiven for believing that the Government and the media place little value on the current service delivered by practices and that radical reform is the only solution.
GP workload
About 36,000 GPs see on average 15% of the population in any 2 week period, that is over 250,000,000 consultations per year.
And what are the core values of UK General Practice?
• Care organised around a registered list
This is valued by patients who generally like belonging to a practice
• Responsibility to the individual patient along with responsibility to the community
GPs are the patients advocate, but also have a responsibility to the community they serve
• Life long medical record
This is a unique feature of general practice in this country most healthcare systems around the world do not have this. The care of a person from cradle to grave with medical records is important for patients and GPs.
• Continuity of care
Many people value seeing a doctor they know and trust. It is especially important for those people who have long term medical conditions.
• Knowledge of the family
Illness often has an impact on the wider family and working in a community allow the knowledge of the wider family to be an important part of the doctor patient relationship.
• Holistic care
GPs are the last generalists. Hospital doctors have become increasingly specialised. GPs are responsible for not only providing comprehensive care but also coordinating it. They deal with anything from major issues such as heart disease, cancer, diabetes to minor illnesses such as ear infections. As our population gets older there are an increasing number of people with more than one major condition and therefore it is vital that provision of this holistic care continues.
• High quality
General practice is recognised as being a provider of high quality care. GPs do not get it right all the time but the levels of satisfaction are generally high. In 2004 a new system of over 150 quality markers were introduced of which over 100 covered 10 major disease areas. The Department of Health thought that general practice would on average achieve about 75% of these. The fact was that general practice met over 95% of them in the first year and over 97% in the second year.
Quality remains an important issue as the variation between the best and the worst is too wide.
• Low cost
General practice financial resources are about 20p per day for each registered patient they look after.
Each GP consultation costs about £20 compared to £24 for walk-in centres and £74 for A/E
The complexity of a GP consultation is generally far greater than one seen in a walk-in clinic.
Most of these are highly valued by patients but are not easily measurable.
There is good evidence that societies with GP-based health services have lower levels of hospital interventions, better outcomes and lower prescribing costs.
So what are the problems?
1. There is an unacceptable variation in quality
The vast majority of practices provide high quality care with appropriate access. A small but significant % do not and the current system has not resolved this issue.
The Government’s current policies do not address the problem either and tendering and commercial provision has had little effect on increasing the quality markers that have and continue to achieve in general practice.
As a profession we must raise standards and improve quality. The British Medical Association‘s (BMA) National Committee of GPs (GPC) and the Royal College of GPs are ready and willing to engage with the Government to find better ways to both recognise and encourage high standards by identifying and addressing those who are falling behind and to support practices and individual GPs to narrow the gaps between the best and the rest.
2. Access
Generally, patients who have long term conditions or see their GP frequently, value the core principles and personal continuity of seeing a small number of healthcare staff and individuals in a local setting. This is one of the reasons why GPs score so highly in patient satisfaction surveys.
There are however another group of citizens, are ill infrequently and who want to see a GP at a time and place of their convenience, who are far less concerned about the core values.
As GPs need to deliver a service to both groups of patients, the population needs to know and understand the trade off between convenience and personal medical care and what they will lose if we move to a “supermarket” style provision of health.
3. Competition
The market philosophy dictates that competition drives down cost and increases quality and the Government does not believe NHS GP practices compete effectively with each other and therefore is encouraging private providers to tender for GP services. External competition is not what will alleviate the Governrment’s perception. Instead, collaboration is far more likely to achieve effective change. Competition can be damaging and what is needed is encouragement for NHS practices to work together and not cut each others’ throats in trying to out-bid potential private providers..
What is the future?
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Care remains organised around the patient, and their needs.
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GPs remain at the centre of this, as the patients advocate and healthcare professional who are in the best position to take responsibility for providing, co-ordinating care and able to signpost patients and their carers/families to the most appropriate service.
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Quality improvement in areas where the gap between best and trailing is at significant variance.
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Managers and clinicians working to a common goal.
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Wider range and greater provision of services in the community.
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Practices working together in collaboration
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The Department of Health being clear on its aims and willing to working with the profession to deliver them.
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National direction but with local flexibility
Is there evidence that commercial providers will provide traditional general practice better than GPs?
Walk-in centres can provide improved access but at a cost and there is some evidence that these services just duplicate existing general practice and add little additional value to patient care.
Polyclinics may be an alternative way of making specialist services more accessible and providing one-stop shops for community and primary services but once again the adverse implications and practicalities appear not to have been thought though. This is a national solution being imposed on every PCT so demographic needs will not be addressed.
So why is the DoH so adamant that commercial companies will be able to provide better quality at a lower cost than current GPs partnerships?
Commercial companies do have something to offer but it is working with practices and not taking them over or setting up in direct competition that will really work effectively for patients.
We need a real debate about where we are going and how we can get there. We need to build on the strengths of general practice in the UK and address quality issues where these are identified as being weaker.
The message to the Department of Health is that if they are really interested in improving general practice then they must work with the profession rather than entering into a conflict as ironically, this will ultimately harm the very voters/patients they maintain they are defending in their determination to change current systems.
Support Your Surgery is a campaign that will highlight to patients the Governments proposed changes, provide important information for patients to consider about the consequences of these changes and allow patients the opportunity to inform the Government of their feelings and the strength of these.