Why do we need General Practice

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Why do we need General Practice?

• Professor Nigel Sparrow
• Vice Chairman
• Royal College of General Practitioners

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(No Transcript)
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What would the health service look like without
general practice?

• Fragmentation of care provided by multiple
  providers
• No registration no continuity, lack of
  aftercare
• Health inequalities exacerbated inverse care
  law
• Competition for patients decisions based on
  cost rather than quality and patient safety
• Patients categorised to diseases

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Why do we need general practice?

• General Practice has been described as the glue
  which holds the NHS together
• Good general practice is essential to an
  efficient and effective NHS
• General practice is the backbone of the NHS
• Patients are never discharged from general
  practice
• Provides a safety net for patients providing
  lifelong services for patients

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Trust in Doctors

• The 2004 annual MORI poll, investigating trust in
  the professions found that 92 of the public
  trust doctors to tell the truth. Further key
  results showed that the public feel doctors are
  hardworking (87), committed (85), and helpful
  (83).
• Link http//www.ipsos-mori.com/polls/trends/trust
  .shtml

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Why do we need general practice?

• 63 million people are registered with a general
  practice
• 90 of healthcare is carried out in primary care
• 15 of the population visit their general
  practice in a 2 week period
• 300 million consultations a year occur in general
  practice
• Most people see their GP at least 3 times a year

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What the NHS Does Contacts per Day (Thousands)

Source NHS Confederation. NHS in the UK 2006/07
a pocket guide. London NHS Confederation, 2006.
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Cost Effectiveness of General Practice
Sources 1. Personal communication with Robin
Beeby, NHS Accounting Processes, Department of
Health. 2. Personal communication with Robin
Beeby, NHS Accounting Processes, Department of
Health. 3. Parliamentary Question, Hansard
Record, 24.01.05. Link http//www.parliament.the
-stationery-office.co.uk/pa/cm200405/cmhansrd/cm05
0124/text/50124w50.htm 4. Department of Health,
Annual Report, 2005. Link http//www.dh.gov.uk/as
setRoot/04/11/37/90/04113790.pdf
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Cost of Different Services in the NHS
Healthcare Commission. State of Healthcare Report
2006. London Healthcare Commission, 2006
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NHS Activity

• An Audit Commission report in 2002 General
  Practice in England used Government expenditure
  plans to show the position of general practice in
  relation to all health services. It showed that
  general practice accounted for 80 of all NHS
  activity (with community and hospital services
  accounting for the remainder) and only attracted
  21 of expenditure.

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Number of GPs and Consultants
Consultants (including Directors of public
health) Source http//www.ic.nhs.uk/pubs/nhsstaff
/mdbulletintab/file (Worksheet 2b) 2. General
Practitioners (excluding GP registrars and GP
retainers) and GP Retainers. Source
http//www.ic.nhs.uk/pubs/nhsstaff/gpbulletintab/f
ile (Worksheet 1b)
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What we do in general practice?

• We are specialists in the individual patient
  rather than being confined to one disease or area
  of the body
• General practice provides a wide range of
  specialist services drug misuse treatment,
  preventive clinics, minor surgery

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Why is UK general practice successful?

• Registered list ensures continuity, lifelong
  record and relationship based care
• Prevention in embedded eg high uptake of
  immunisation and cervical cytology. Opportunistic
  linked preventive interventions
• Most patients with common chronic diseases are
  managed exclusively in general practice
• Gatekeeper and navigator role ensures that those
  who need specialist high technology care can
  receive it
• Primary care is close to patients

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Mortality/Morbidity and Primary Care

• Shi (1994) found, in the US, that primary care is
  by far the most significant variable related to
  better health status, correlating to lower
  overall mortality, lower death rates due to
  diseases of the heart and cancer, longer life
  expectancy, lower neonatal death rate, and low
  birth weight.
• In studies undertaken by Shi and Starfield (2000,
  2001) on income inequality and primary care, an
  association was established between higher
  primary physician supply and good health status.

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The role of general practice in the current
aspirations of the NHS

• Improved access to care
• An improved patient experience with personalised
  care
• High quality chronic disease management
• Reducing the need for specialist referral
• Improvement in the health of the public

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A vision for the future

• Practices working together by sharing expertise
  and capacity
• Training model for health care professionals
  emphasising patient centredness and communication
  skills

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Challenges for primary care

• Recognition and management of co-morbidity
• Preventing adverse effects of medical
  interventions
• Further improvement of standards of primary care
  practice
• Improve equity in health services and in health
  of populations

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Future of General Practice

• Continuity with a named doctor and nurse
• Longer and flexible consultation times
• Focus on prevention, health and well being
• Earlier diagnosis
• More support for patients in information and self
  care
• Integrated teams
• More tests and procedures in primary care
• Strong general practice services in deprived
  areas

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The value of good general practice

• Despite all the changes, the values of general
  practice are important
• Standards and quality of patient care are
  essential
• Patients need safe effective care provided by
  skilled highly trained professionals
• Remember general practice is about co-morbidities
  not just single diseases
• Good general practice is essential for patients,
  for society and for the NHS