It is a difficult question and one that has perhaps already been answered. Despite a significant real term increase in funding for General Practice – they are still in trouble. It is just not enough and unless demand can be managed or possibly reduced then General Practice in its present form cannot be sustained. I should add that I am a great supporter of practice pharmacists – in fact every practice should have at least one. Skill mix is important, but is it the only solution – how much can we do within the existing funding cap is demand rises by 5% a year?
GPs can’t be everything to everybody. You can’t deal with ill-health and wellness and the current social disaster of poverty and lack of elderly care all by yourselves – something has to give. You can’t be in your practice, in A&E, running urgent care, in the care home, leading commissioning and now running gardening clubs – it is just not possible. However, here is something valuable about continuity of care, the ‘family doctor’ and knowing and trusting that there is a GP there when we all need one. It is a balancing act and General Practice cannot be the sponge for every worry, but it is far too valuable to risk losing.
So here are a few suggestions:
- Managing demand is about triage and offering alternatives. Get behind the NHS Alliance document ‘supporting the development of community pharmacy practice’. Start to see community pharmacy as just an extension of the practice – looking after patients with more common acute complaints (minor ailments) and as a discharge route for patients to take over their own care. Think about how you can help community pharmacists look after more of your patients, more of the time. Can you offer skype access to support their growing experience and fast track appointments?
- Reducing demand is about developing the ability of individuals and local communities to create their own health and wellbeing. It was mentioned briefly in the Next Steps to the 5 year forward view. We all know that creating health is so very different from treating illness and GPs need to be supporters of the creation of primary care based health and wellness hubs that can engage the power of communities. It changes the question from ‘what is the matter with you’ to ‘what matters to you’. Activities like these can make a significant reduction in attendances in General Practice and Urgent and Emergancy Care. See some of the work that the NHS Alliance is doing on this.
- Bringing in local providers. Please don’t try to solve all problems – just rent a room. There are others that can give people advice on welfare, benefits and housing and deliver social prescribing – build that relationship. It would be even better if they were located out of the practice, perhaps in community pharmacy or community owned facilities. Have you thought about engaging housing associations – they want the same outcomes as you – fit and health residents that can manage their long term conditions without going to hospital.
- Breaking the boundaries between ill-health and wellness. While GPs offer medical services to people who are well then there is no boundary in peoples’ minds. It is easier to think that if I am ill I go to see a doctor – but if I am well then I go and see someone else. This may lead to alternative provision of some services, but I understand, for example, that community pharmacists in New Zealand can offer contraceptive services. It is not about skill mix in general practice – this one is about defining what a GP practice does and then creating partnerships.
I, for one, want General Practice to survive. To be there when I need you and to see faces that I recognise and know me. I want to be in control of my own health, knowing that there are people who can help me to reach my goals and the GP is the conductor in the background, but there when I need him/her. I would prefer to get my results locally – perhaps in the community pharmacy so I can own my condition. However it is time to face the facts – you are not going to get what you need – and you need to think differently.