The BMA has called for a “meaningful programme of reform” to create a general practice that meets the needs of patients and attracts new graduates to the profession. Not implementing such changes “would be nothing short of a dereliction of [the government’s] duty to care for the nation’s health,” said Chaand Nagpaul, chair of the BMA’s General Practitioners Committee.
After a two year consultation with patients, doctors, and other stakeholders, the BMA said that patients want to continue to see primary healthcare delivered by GPs based in the community and not by commercial companies or by GPs based in hospitals.
The association’s blueprint for the future of general practice pours cold water over the government’s plans for a seven day routine service across the NHS1: patients “appear unconvinced” that this is the best way to improve access to care, the BMA document said. And GPs share this view, it added, “seeing greater investment in the current 24/7 GP urgent care service as a more sensible way to meet patient need” than evening or weekend appointments.
The consultation has shown that patients and doctors both recognise the need for change. While patients acknowledge that larger practices have benefits over small surgeries, they still want a GP who knows their history. And, while GPs support the independent contractor status, two thirds of salaried and locum GPs have said they do not want to be a partner in a practice.
Modern general practice relies on developing new models of care, the BMA recommended, such as a collaborative model with bigger teams that can work in networks to deliver social care, as well as healthcare and other services. An alternative is the super practice model, delivering care to a much larger number of patients—say, 100 000—through various sites, with specialist services at just some of these.
A comprehensive strategy is also needed to boost GP numbers, the association said. Some nine in 10 GPs who responded to a BMA survey said that workload pressures were already damaging the quality of care that GPs can deliver. But new medical graduates are reluctant to enter general practice, as more than 600 vacancies for GP trainee places across England were left vacant last month,2 and a third of GPs plan to retire in the next five years.
To tackle the shortfall, general practice needs an image boost in medical schools, more resources must focus on increasing GP placements for foundation doctors and returners, and a fair tariff for GP practice undergraduate placements is needed so that all practices across the country can participate, the BMA said.
The association also repeated its call for better funding for general practice, which currently stands at £131.45 a patient a year and has faced underinvestment for the past decade.
On top of these requests the BMA recommended a modernisation programme for GP premises and the better use of technology to improve patient care and lessen unnecessary workloads, including phasing out paper records.
Nagpaul said, “Rather than focusing on piecemeal changes or unrealistic politically driven plans, such as compelling practices to open all week when they have neither the resource nor the capacity, we need a meaningful programme of reform that creates a sustainable, modern, and flexible service.
“We need better, more focused ways of lessening the overwhelming workload undermining GP services through better self care, effective use of new technologies, and appropriate funding.
“It is vital that the government addresses the problems facing GP services: a failure to do so would be nothing short of a dereliction of its duty to care for the nation’s health.”
By Zosia Kmietowicz, The BMJ