How good is the quality of general practice in England?

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How good is the quality of general practice in England? An independent panel commissioned by the Fund provided an answer to this question this morning. The panel's conclusions are robust and well-informed, showing that overall quality is pretty good, but that it varies widely, and there are gaps in quality that need sorting.

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.

This blog also appeared on the Guardian healthcare network website.


Mrs H Martin

Comment date
27 June 2011
My daughter saw her local doctor in Germany, she had an initial review, was x-rayed and put in plaster within the hour, all sorted at the GP's practice. Why can't we do this?
I spend most of my time at the GP's waiting around in cues for the doctor, then being told to book an appointment for the nurse and then having to come back again next week! Why don't we get rid of the doctor, lets face it, the nurse tends to know it anyway. We could then employ fewer doctors for emergencies only. This might save all of us, our time and money.

George Farrelly

The Tredegar Practice
Comment date
08 May 2011
Do you feel that the proposal to abolish practice boundaries will improve patient care, improve the quality of general practice, 'make care closer to home a reality, and...reduce the inappropriate use of hospitals'? If yes, how?

Harish Mistry

Comment date
28 March 2011
I totally agree that we need to be efficient. all professionals need to efficient.
But what has the Kennedy reported as to what evidence based changes we should make? They have not suggested ways!
The continual anti general practice agenda is one answer
What about the responsibility of the Goverment & The Kings Fund to look at the demand culture for people accessing health care. There are close to a million general practice consultations a day.
what if there was no general practice for consultations for 5 days?
Will the NHS still exist?
Before everyone continues to knock GPs and why they vary think twice pimary care is not easy and with the extensive NHS cuts in the pipeline it is not going to get easier for us GPs.
The suggestion of care pathways are great but "Patients with complex illnesses/problems either physical or psychological do not always fit into a pattern"

paul caldwell

Comment date
26 March 2011
if the quality is generally good, patients are generally satisfied, the variations do not seem to affect outcome and the Panel could not come up with a new set of robust quality indicator, why change the system at the considerable risk in these financially stressed days of introducing something worse? It sbroadly working, why fix it? leave things alone and accept that variation will happen. BTW, what is wrong with variation (somebody has to be above or below average)?, particularly when the Panel found it difficult to explain except possibly by external factors outwith the ability of clinician to affect.

Phil Lucas

Faster horse,
Comment date
25 March 2011
Disruptive innovation, my eye! This sounds like a good old-fashioned fudge recipe. For inquiry read opinions of a small group of usual suspects. "Overall quality of primary care good...not ready to do anything too difficult." I'm not surprised it was endorsed by the BMA and RCGP. It perfectly reflects the "representative" bodies' love of a life spent carping from the sidelines.

Nick Goodwin

Senior Fellow,
The King's Fund
Comment date
24 March 2011
The inquiry was chaired by Sir Ian Kennedy, Emeritus Professor of Health, Law and Ethics at University College London and Chair of the Independent Parliamentary Standards Authority. Sir Ian is a former chair of the Healthcare Commission and chaired the public inquiry into children's heart surgery at the Bristol Royal Infirmary. He took over from the previous Chair, Niall Dickson, in October 2009, following his departure as Chief Executive of The King’s Fund.

The other members of the independent panel were:

• Dr Michael Dixon, Chair, NHS Alliance
• Professor Steve Field, former President of the Royal College of General Practitioners
• Ursula Gallagher, Director of Quality, Clinical Governance and Clinical Practice, Ealing PCT
• Dr Rebecca Rosen, Senior Fellow, The Nuffield Trust

The panel was recruited by Niall Dickson so that the inquiry be led by expert in general practice.

Chris' challenges to general practices as set out in this blog represent his response to what the Inquiry has said.

To get a fuller picture of what the Panel has reported in then please do read the report - both the RCGP and BMA have accepted and welcomed much of what is written in it.

John Garrow

retired physician,
Comment date
24 March 2011
Please explain how you recruited an "independent" inquiry panel to assess the performance of GPs. Did members of the panel not have any contact with GPs? Have they any experience of primary care? One of my children is a GP: would that disqualify me? Please reveal the criteria on which you selected the members of this panel.

Thank you. John Garrow

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