Reshaping general practice from within

I left our recent conference on the role of general practice feeling upbeat. Throughout the day we heard about a range of new ways in which GPs and primary health care teams are engaging with others to deliver more community-based care to frail older people and people living with long-term conditions so that hospital care is no longer the default option. So what are some of the primary care innovations happening both abroad and in the UK?

Craig Tanio and Gordon Chen from ChenMed in the United States spoke about their scaleable primary care-led delivery model, which offers pro-active and systematic care to patients with complex needs over the age of 55. The delivery model includes a one-stop shop for delivering multi-specialty services like onsite diagnostics (with physicians working alongside a range of specialists), a smaller patient-to-doctor ratio with 450 patients to every physician, and customised electronic health records for chronically ill patients. These innovations have lowered rates of hospital use, improved patients’ adherence to medication and led to higher rates of patient satisfaction.

Critically, ChenMed have designed processes and structures to promote a culture of collaboration, transparency and accountability among the physicians they employ. For example, their primary care physicians meet three times a week to review hospitalised patients and other complex cases. Hospital specialists are invited to these meetings and the physicians talk through the clinical decisions taken together. Activating the professional culture in this way appears to have had a positive impact on staff motivation and on relationships between hospital and primary care physicians.

One panellist at the conference – a GP – noted how the ChenMed model of care reminded him of the strong professional culture in UK general practice in the late 1960s and 1970s. Another panellist spoke of general practice in the UK today losing its way – I disagree; this may be the case in some parts of the country yet throughout the day we heard a number of examples of how GPs are instigating and leading the development of alternative care delivery models.

At the conference we also heard some great examples of GPs using the monies from the Prime Minister’s Challenge Fund to re-shape local general practice. For example, in Folkestone GPs are enhancing community and out-of-hospital specialist services by setting up ‘branch surgeries,’ which will be open from 8 in the morning to 8 at night, seven days a week. These surgeries will be supported by staff from a range of local organisations. Although it’s very early days, it is hoped that this new operating model may also provide interesting and rewarding professional roles for GPs within a training environment.

GPs in north Yorkshire told us how they have formed a new GP provider organisation (22 practices with a population of 142,000) to support the needs of their ageing population in a more sustainable way. In this rural and sparsely populated part of the country the local GPs are keen to start delivering care differently and more collaboratively. Initial plans include working with the local paramedic service and setting up integrated health and social care teams to systematically and pro-actively deliver care to all those aged 75 and over.

In Brighton and Hove, GPs are using the funds from the Challenge Fund to extend primary integrated care. This involves GPs working with nurse practitioners, pharmacists and the voluntary sector to deliver services and care to local people in different ways – for example, by establishing a team to respond to emergencies and people wishing for a ‘same day appointment’. A key element of the new model is for neighbouring practices to share resources and back office functions so that they can offer a wider and more efficient local service. We also heard how the super GP partnership in the Midlands – Vitality Partnership – plans to use digital technology to support patients more so that they can take control in managing their own long-term conditions.

So as well as looking across to America for solutions on how to re-invent English general practice, perhaps we should also be looking more carefully at some of the new home-grown models of primary care that are emerging and exploring how we can support their development.