Demand for general practice has never been higher. Over a million appointments are delivered each day in GP surgeries, with general practitioners delivering two-thirds of appointments themselves. Rising demand within a system too heavily reliant on GP services is, however, making these uniquely-skilled individuals stressed, tired and demotivated. Yesterday, the Royal College of General Practitioners (RCGP) urged overworked GPs to take a break to ensure patient safety.
The RCGP’s longer-term solution is to increase the number of GPs by 8,000. The Government has committed to employ 5,000 more GPs by 2020-21. These plans intend to reduce the burden on GPs.
Unfortunately, they fail to solve a deeper problem within general practice. Policymakers must accept that the current model – built for 1948 – is broken. A new workforce is needed to meet demand. Experts interviewed for a Reform report published today explained that 50 per cent of appointments currently provided by GPs could be delivered by other clinicians. If nurses delivered the 15 per cent of appointments dealing with minor ailments – as they are well-placed to do – the NHS would save over £700 million a year.
These changes will not only ease GPs’ workload – practitioners also explained that they would free GPs to focus on the complex medical problems they are trained to solve. More time would also enable GPs to provider longer appointments, up to 20 minutes, for those in greatest need – another aim of the RCGP.
To facilitate a more efficient workforce, GPs must embrace technology. Only 7 per cent of people report using the internet to book appointments. More sophisticated triaging systems can reduce demand on an overstretched general practice. One system, trialled across 20 practices serving 130,000 patients in London, suggests that around a fifth of people who follow online signposting will seek self-care. If the proportion who used this information matched the number of people who use the internet each day, savings could reach £250 million per year.
For those who require care, video consultations should become the norm. Waiting in GP waiting rooms has become a miserable tradition for many. Contacting clinicians from a living room is much more appealing. It also saves time: video consultations are 40 per cent quicker than face-to-face meetings, excluding waiting times. Private-sector companies, such as Babylon Health, are pioneering this approach by allowing people to contact their GP through their smartphone: sending text messages, photos and prescription requests. In 2016, this should be the norm in the NHS.
Only a handful of providers currently have the capacity to deliver a new approach. The average GP practice covers 7,500 patients. As Professor Robert Harris, Chief Executive Officer at Lakeside Healthcare, which serves over 100,000 patients in Northamptonshire argues for Reform today, size has been the key enabler of diversifying the workforce and embracing technology. Modality Partnership, covering 70,000 people in Birmingham, cites scale as crucial for investing in technology to book appointments.
GPs are critical for delivering high-quality care at a low cost to the taxpayer. The unnecessary demand currently heaped upon them will undermine their ability to do this. Understanding this is critical to unlocking a sustainable approach to providing care for all who need it.
Alexander Hitchcock is a researcher at the public services think tank Reform. Its new report ‘Who cares? The future of general practice’ is available at www.reform.uk