Declining continuity of NHS care poses ‘existential threat’ to patient safety | GPS
Rapidly falling levels of continuity of care pose an ‘existential threat’ to patient safety, Britain’s top family doctor will warn today, as research finds only half of Britons regularly see the same GP.
Professor Martin Marshall, president of the Royal College of GPs (RCGP), will say that trusting relationships between family doctors and patients are ‘the most powerful intervention’ for delivering high-quality, effective care because they improve patient satisfaction and health outcomes, and reduce the use of hospital services.
But in a keynote address to the college’s annual conference, Marshall will warn that continuity of care is becoming nearly impossible to deliver on the NHS amid rising demand and a dwindling number of GPs, in what he will describe as the “most worrying crisis in decades”. .
There are growing concerns about the NHS’s ability to tackle record high waiting lists, with 6.5 million patients awaiting care in England alone. Earlier this month Sajid Javid, the Health Secretary, admitted the current model of GP care ‘isn’t working’ but insisted there would be no more money for the health service.
Marshall’s intervention comes after GPs in England threatened on Tuesday to take industrial action over a contract that requires them to offer evening and weekend appointments.
Doctors at the British Medical Association (BMA) annual conference in Brighton have called on union leaders to act on a 2021 indicative ballot and ‘organise opposition’ to the contract, ‘including industrial action if necessary’. GPs are unlikely to stop providing emergency and emergency care, but could refuse to carry out other routine work or reduce their hours.
At the RCGP conference in London, Marshall will tell delegates that due to increased workloads and shrinking staff, GPs no longer have time to properly assess patients, with 65 % warning, safety is compromised due to appointments being too short, according to a recent survey commissioned by the college.
Only 39% of respondents said they were able to provide the continuity of care their patients need, down from 60% two years ago.
The findings are supported by a separate study published today. A Queen Mary University of London review of 1 million NHS patients found that half (52%) regularly see the same GP despite growing evidence of improved clinical outcomes. Research has found that patients who benefit the most from seeing the same GP are those with long-term health conditions and people who visit a practice frequently.
However, Marshall will tell delegates that the current state of general practice in the UK is ‘not conducive’ to ‘relationship building’, adding: ‘On average three issues are presented in a consultation of 9 .8 minutes – the second shortest consultations in Europe after Germany.
“At a time of increasing workloads and shrinking GP workforce sizes, as is the case in the UK, this may require an overhaul of the way we work, with a moving from GP-as-all-things-to-all-people to a more targeted approach, where we add value as part of a larger professional team – and continuity of care is one of those areas.
Marshall will suggest that continuity of care can still be provided, but perhaps not in the way it used to be. “Continuity of care is a defining characteristic of family medicine, but physicians should not have a monopoly on its delivery,” he said, citing examples of when good patient relations are nurtured by more a clinician, such as nurses or physiotherapists.
Meanwhile, Tony Blair is today urging England’s health service to radically reform the way it works in order to remain viable, saying ‘the NHS is a service, not a religion’.
A new report from the Institute for Global Change by the former Prime Minister warns that the NHS as a whole risks going down the same path as dentistry, with patients unable to get the care they need.
In his foreword, Blair argues that the founding principles of the service – that it be accessible to all, free at the point of use and funded by general taxation – must remain in place. “However, the NHS envisioned by Sir William Beveridge and Aneurin Bevan – a centralised, ‘one size fits all’ service focused on how we treat sick people – no longer meets the demands of today’s world.
“How the NHS is set up and organized should not and cannot be a matter of belief, but of practice. As currently constituted, the NHS cannot be the service we need now.
Ministers and NHS bosses must embrace technology and innovation such as AI on a much larger scale, focus more on disease prevention and enable the 42 new ‘integrated care systems’ – clusters of NHS bodies launching Friday – freedom from central control to decide for themselves how best to deliver healthcare in their area, the report says.
On Wednesday, ministers will outline plans for a huge increase in the number of patients self-monitoring and being treated at home in “virtual wards” in a bid to reduce pressure on overwhelmed hospitals.