The panel also asked whether general practice is really set up and fit to deliver what's needed for the future: to which the answer is no.
At its heart, general practice remains a cottage industry and the panel quite rightly argues for greater collaboration between practices to support the improvements in care the NHS needs to make. Collaboration is essential to combine accessible and responsive general practice with the benefits of working at scale in federated and networked models of care. These benefits include access to a wider range of skills from extended teams; the shared use of technologies and services; and the ability to work with peers to measure and improve the quality of care in a supportive environment. General practices are already evolving in this direction and the panel's report will add impetus to these developments.
In an age when chronic diseases such as diabetes and heart failure are increasingly common, patients need access to integrated care, and yet this is not always easy given the historical division in British medicine and the physical separation of generalists and specialists. Collaboration between practices has the potential to bridge this divide – and improve outcomes – by allowing specialists, whose work is increasingly community-oriented, to work alongside primary care teams.
Clinical integration is needed not least for the NHS to make care closer to home a reality, and to reduce the inappropriate use of hospitals. Too often, patients are admitted to hospitals because of a lack of alternative forms of support and care, or because general practitioners face difficulty in accessing specialists and experienced nurses quickly in times of crisis. My vision of the future is one in which general practitioners and their teams work with geriatricians, paediatricians and other specialists in care networks to help patients remain independent in their own homes for as long as possible. A progressive shift of resources from hospitals to the community is needed to make this happen.
Henry Ford once famously said that in developing the motor car there was a choice between breeding a faster horse and doing something quite different. Ford's pioneering example of disruptive innovation has since been emulated in many other sectors, including banking, telecommunications and the airline industry. Health care has evolved more gradually and the time is now right to take a more radical look at how the strengths of general practice can be built on in the challenging times that lie ahead. The gauntlet thrown down by the inquiry panel is to accelerate the pace of improvement in general practice and to move beyond the cottage industry to a collaborative and integrated system that is fit for the future.
- Find out about the Inquiry into the Quality of General Practice in England
- This blog also appeared on the Guardian healthcare network website