The traditional GP practice is under pressure from rising demand, a shortage of GPs and the preferences of a new generation of doctors. But any reform must retain and enhance its key strengths as a model of community-based service. John Copps looks at whether and how cooperative principles could help find a more sustainable solution.
One of the key strengths of primary care in the UK, almost everyone agrees, is the connection between GPs and the people they serve. At its best, there is a deep bond and people see their surgery as a totem of the community.
But as anyone who has tried to book at appointment recently can see, GP services are under strain. Statistics point to a crisis in recruitment at a time when demand is soaring. Almost every doctor will tell you that their surgeries are busier than ever, workloads are mounting, and there are not enough hours in the day to see all patients. The knock-on impact is being felt across the NHS, including already-busy A&E departments.
At the same time a generation of GPs are entering the profession with different expectations to their predecessors. Surveys show that they want to combine General Practice with a portfolio of other clinical work, and that they are turned off by the administrative demands of being a partner. On the ground, retiring GPs partners are finding it harder and harder to find a successor.
What is the future model of Primary Care?
The current situation feels unsustainable. We need the find a different approach to General Practice.
Any new approach must not throw away what is working. In particular, it should build on and enhance the existing connection with people and place, whilst acknowledging the structural issues.
In this way, cooperative principles can provide a guide for reform. Social partnership between citizens, communities and services. Democratic engagement in setting priorities. Coproduction that allows citizens to be equal partners in designing and commissioning public services. Embracing innovation. Focusing on maximising social value. All these aspects can help to create more robust leadership and organisational structures, as well as enhance the strengths of existing services.
The 2022 'Fuller stocktake', undertaken by GP Dr Claire Fuller, looked at how to accelerate integrated primary care - incorporating general practice, community pharmacy, dentistry and optometry - with better access, multi-disciplinary neighbourhood teams, and 'aligned' leadership. In short, for Dr Fuller, cooperation with communities and collaboration between services is part of the solution.
What might this look like? How can cooperative principles support change?
Cooperation with communities
The traditional GP Partnership model depends on ownership of practices as independent businesses by doctors. That works where there are GPs willing to be owners (and take on the risk, liability and administration of staff, premises and equipment), but is failing where increasing number of GPs say that they don’t want that.
For example, I have done some work with a group of practices in the South of England where the existing delivery model was not sustainable ias it relied on the continued operational and financial commitment of the sole Partner. The partner was approaching retirement, which posed significant risk services.
A solution to this is a different model - one where GPs are still at the centre but that are less reliant on them for the non-clinical parts of running a business. Already there are examples such as Bevan, a social enterprise established in 2011 to support patients with complex needs in West Yorkshire, Granta Medical Practices in Cambridgeshire, a group of practices moving into a limited liability company with shares held by an Employee Ownership Trust, and Symphony Healthcare Services, a wholly-owned subsidiary of Yeovil District Hospital NHS Foundation Trust.
Models like these can provide opportunity for greater staff and community involvement in governance, enhancing the link between people and place as well as providing a more resilience structure.
Collaboration between services
GPs should remain at the centre of care but patients could and should spend more time with other clinicians.
Done well, an expanded definition of primary care can be transformative for local communities, with patients seen by the right professional, at the right time, in the right place.
PCNs are already paving the way for this - including through additional roles such as social prescribers - although progress feels slow. There is signficant variation between areas as they interpret their roles differently and adopt the changes with varying levels of enthusiasm.
As emphasis across the system shifts to collaborative arrangements and 'place-based' care, primary care has the opportunity to forge stronger partnership with NHS community providers, local councils and the voluntary sector. There are provide collaboratives emerging across the country doing just this, including in In South Yorkshire where a GP Federation and Community and Mental Health Foundation Trust are using a focus on health inequalities and workforce changes to make progress on improving pathywas around frailty.
Primary care must adapt. There is room for different ways of involving and engaging with the community and other services. To support that much-needed change let cooperative principles help guide the way to better, more sustainable ways of working!
To learn more about the themes in this article or how MV could help your service embrace cooperative principles contact john@mutualventures.co.uk.
MV is a proud to be an affiliate member of the Cooperative Councils Innovation Network. Read more about the Network at www.councils.coop.
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