General practice is one of the most important and respected institutions in our communities; it is the foundation of the NHS. It has been credited as a major reason for the NHS being one of the most cost-effective models of healthcare, outperforming many countries in the Western world which spend significantly more on their health care systems.
The strengths of general practice that deliver these outcomes include:
- organising care based on a registered list, with the vast majority of the population registered with a practice;
- providing care from cradle to grave;
- having a holistic approach to care, looking after the whole person and not simply focusing on one disease or a single episode of care;
- knowing more than one generation in a family, having a lifelong medical record;
- providing continuity of care where needed;
- and managing the undifferentiated presentation of symptoms.
In recent years partnerships have become less popular with GPs and there is a risk that, without both the continued commitment of existing partners and the input of new partners, the model could be lost.
Talking about this possibility Dr Nigel Watson, who lead the review, said: "In my view, and the views of the vast majority of those who have contributed to this review, this would be a real loss to both general practice and the patients and communities it serves. I firmly believe it is important to consider the strengths of the partnership model of general practice, and what value the model offers above and beyond an alternative salaried model."
Strengths of the Partnerships Model
- the freedom to innovate;
- relative autonomy in decisions relating to patient care, with the ability to act as a powerful independent advocate for patients;
- being part of, and accountable to, a community;
- creating the desire to succeed as business owners;
- providing value for money.
Weaknesses of the Partnership Model
- GPs do not feel valued as a profession, and that general practice does not feel valued in all local health systems.
- GPs' workload is exceeding capacity, the working day feels unmanageable, and the intensity of work and the complexity of patients has risen, with inevitable challenges in terms of managing clinical risk.
- The balance between continuity of care and access to services, has been eroded. Care over a period of time with a person you know and trust ('relational continuity') is at the heart of general practice, valued by patients and GPs alike and shown to deliver better outcomes.
Looking to the Future
- The NHS is moving towards a team-based multidisciplinary way of delivering care, which must involve general practice working more closely with colleagues in primary, secondary and community care and ensuring we make the best use of all skills.
- In recent years an increasing share of the NHS budget has been invested in hospital-based care at the expense of general practice, community services and mental health. The additional £4.5 billion of investment for primary and community care recently announced in the NHS Long Term Plan is a step in the right direction to address this imbalance.
- More GPs are entering training than ever before, addressing some of the important concerns around recruitment.
- The personal risk and unlimited liability currently associated with GP partnerships needs to be reduced.
- There needs to be a wide range and number of healthcare professionals available for services in the community, embedded as part of general practice
- Funding for GP training places should be increased and a more specialised focus in medical training on general practice as a positive career choice should be introduced.