Transforming care in England

One of the  challenges identified by the Kings Fund for the NHS in England is developing new and better models of care – they write:

The ageing population, changing patterns of disease – with more people living with multiple long-term conditions – and rising public and patient expectations mean that fundamental changes are required to the way in which care is delivered (see Transforming the delivery of health and social care: the case for fundamental change).

What should be done?

Realising this transformation will require a radical shift to involve individuals more fully in their own health and care. This will include making shared decision-making a reality, giving people the support and information they need for effective self-management, involving families and carers, giving people personal budgets where appropriate, and engaging people in keeping healthy. The evidence is clear: most people want to be more involved, and when they are, decisions are better, health and health outcomes improve, and resources are allocated more efficiently.

Health Care

Much greater priority should also be given to public health and prevention. Because of the complex range of influences on population health, this will require collaboration between the NHS, local government, the third sector, employers and others. It will also require action by government, as exemplified by the proposed levy on the soft drinks industry to help tackle childhood obesity. We have outlined opportunities for local authorities to use their powers to improve the health of their populations as part of a broader move towards population health systems.

The implementation of new care models should build on those outlined in the NHS five year forward view. Closer clinical and service integration is needed between hospitals, community services and general practices, health and social care, and physical and mental health. Our work has described examples of specialists working more closely with primary care teams and of general practices collaborating in federations and networks to show how new care models can contribute.

We need a workforce that is fit for purpose, able to adapt to changing demographics and aligned to the new care models outlined in the Forward View. To address this, a national workforce strategy is needed to attract, train, retain and develop the talent it requires to succeed in the long term. This strategy should include consideration of remuneration, training, culture and career development.

We also need to embrace innovations in digital and other technologies, for example, implementing an electronic care record to facilitate access to information about patients wherever they seek care.

“The challenges are immense and the outcomes could be for better or worse”

Understanding pressures in general practice – The Kings Fund

Increasing demands on general practice over the past five years – not just a heavier workload but the increasing complexity and intensity of work – have led to a feeling of crisis. The NHS is finding it difficult to recruit and retain sufficient GPs who want to do full-time, patient-facing work.

Key findings

  • GP workload has grown hugely, both in volume and complexity. The research sample shows a 15 per cent overall increase in contacts: a 13 per cent increase in face-to-face contacts and a 63 per cent increase in telephone contacts.
  • Population changes account for some of this increase, but changes in medical technology and new ways of treating patients also play a role.
  • Wider system factors have compounded the situation. For example, changes in other services such as community nursing, mental health and care homes are putting additional pressure on general practice. Communication issues with secondary care colleagues have exacerbated GP workload.
  • Increase in workload has not been matched by a transfer in the proportion of funding or staff.
  • The number of GPs has grown more quickly than the population but has not kept pace with groups most likely to use primary care (over 65s and over 85s).
  • GPs are increasingly opting for ‘portfolio careers’ or part-time work. Only 11 per cent of GP trainees surveyed intend to do full-time clinical work five years after qualification.

King's Fund

Policy implications

  • Commissioners and policy-makers must have access to national and local data for secondary use for primary care. They cannot plan effectively or understand the impact of their decisions unless they understand how GP activity is changing.
  • Improvements to the existing system should prioritise structured support for general practice, redesign of commissioning systems to reduce bureaucratic burdens, repairing relationships between primary and secondary care, more use of technology, and better utilisation of community assets to meet patients’ needs.
  • New models of general practice should include new types of delivery, striking a balance between working at scale and making services responsive to local people.
  • The service needs a workforce strategy that supports more sustainable careers for GPs and other team members, while recognising changing career preferences.
  • Policies to change and extend access must be accompanied by commensurate increases in funding and support.

The Kings Fund report report uses qualitative and quantitative data to assess the various factors driving current pressures in general practice.
It is available at: http://shop.kingsfund.org.uk/products/understanding-pressures-in-general-practice

“Can our health services pull back from the brink ?”