DO NOT USE re-thinking the location of care

Patients recover better in their own homes and sustainable healthcare in this country requires healthcare professionals to recognise the limitations of hospital care. Hospitals should be for acute healthcare needs requiring 24 hour monitoring only.

Love this program!

I read again the factoid that 3/4 of people wish to die at home, nobody ever references this. As more elderly people end up in residential care we need to reassess this figure. Do we really know where the elderly wish to die? The young know they wish to die at home because they have never seen a death at home.
Has anyone got a good paper for me to read?

primary care in the future will mean patients will have much more choice leaving those providers that perform poorly in the views of the service user with less and less patients. Although less choice isn't always good it will ensure good services can expand and poor services may not survive. General Practice will only survive by focussing on providing a quality service the meets the needs of its population

Although GP has never been perfect, some of the current changes in the NHS seem to be accelerating the decline in the distinctive roles of GP, which further undermines the efficiency and effectiveness of a clear NHS primary care/secondary interface. Discussions about a national service always often seem prejudiced by a local or personal experience. London GP has always been v different from the rest of England. Urban with high turnover of patients is different from rural with low turnover. Social class 1 different from social class 5 etc. GP is very different everywhere.
However Quality of GP anywhere can be judged by good access to care, best treatments, customer satisfaction, a depth of care, efficient and effective care, and fair treatment for all.
The nature of GP has been changed and its needs to make its unique selling point (USP) clear. GP is no longer the first point of contact and gatekeeper. Patients increasingly access the EDs, OOH, WIC, 111, NHS Direct, 999 & paramedics for urgent care. GPs are now coping keeping up to date with the ever changing best treatments and the increasing demands for the chronic disease management, self limiting illnesses of the worried well, anxiety and depression. Unsurprisingly customer satisfaction in a critical consumer society that expects GPs to be able to do almost anything and quickly is worsening with trust in GPs declining and complaints to Med defence societies increasing. Depth of care is eroded by all the different types of specialist nurses and the like who undermine (but may improve) GP care. Efficiency and effectiveness can be managed but its hard if GPs are continually expected to do more with less resources. Fairness is difficult as for example the somatisers who see GPs often take resources from the normalisers who avoid GPs.

What are the priorities for the future of general practice? First is the essential of general practice – trust is still the vital ingredient in GP-patient relationships. Annual Yougov polls always show that GPs are the most trusted profession, but the same polls also show that this trust gets less each year. Trust should be the keystone of GP. Second is real general practice – one where we understand there will always be different perspectives on a problem, where we recognize the limits of our personal knowledge and the resources available, where we know that compromise is the usual way forward, and that things will probably get worse before they get better. GP should be a resource for common sense and wisdom for patients. Lastly and importantly we need continuity in general practice - where in an increasingly fragmented system patients know their personal GP and enjoy the continuity of care that lets their own GP listen, care, and then do the right thing for them. Continuity should be our unique selling point.

The future of general practice must be based on continuity of care, trust and common sense wisdom.

Re preferences to die at home have a look at 'What do we know now that we did't know a year ago? - new intelligence on end of life care in England' Published by the National End of Life Care Intelligence Network. Has references to surveys as well as electronic records re palliative care.