Rosen, R. | (2018) | Divided we fall: getting the best out of general practice| Research report| Nuffield Trust
The traditional model of general practice, sometimes called ‘medical generalism’, involves GPs developing a relationship with a patient, and understanding their social and family background. It can make them more able to decide when medical treatment is not helpful or necessary, and to manage patients safely outside hospital. This report asks what might be lost as doctors and patients are reallocated to services focused on easy access, such as walk -in centres. Are general practitioners at risk of losing the value this delivers to patients and the wider NHS? (Nuffield Trust)
The report considers what GPs and national NHS bodies can do to get the best of both worlds.
It is available from the Nuffield Trust
Volunteering in general practice: Opportunities and insights | The Kings Fund
The King’s Fund has published ‘Volunteering in general practice: opportunities and insights‘. This paper explores how volunteers can provide support for the role of general practice, and the opportunities for organisations that currently support volunteering to work more closely with general practice.
Interest is growing in the contribution that volunteering can make in health and social care. This paper builds on our previous work, which examined volunteering in hospitals, to explore ways in which volunteers are involved with, and are contributing to, general practice.
The authors identify four approaches to supporting volunteering in general practice: use of volunteers to enable general practice to carry out its activities; organisations using volunteer support that were located within general practice premises; social prescribing; and community-centred general practices.
10 case studies are explored, which demonstrate that approaches to supporting volunteering in general practice provide an opportunity for practices to engage beyond their traditional boundaries, creating an interface with voluntary and community sector organisations and with the wider community.
The practice examples highlight the importance of partnership work to support and sustain volunteering, the different design and resource considerations in choosing an appropriate approach, the support and management requirements for volunteers and strategic factors that influence success and sustainability.
Review of 9 qualitative studies reports people do not attend NHS Health Checks because of the lack of awareness, misunderstanding the purpose of the Health Check, aversion to preventive medicine, time constraints, and difficulties with access to general practices.
The findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.
To examine associations between the contract and ownership type of general practices and patient experience in England. Design
Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting
All general practices in England in 2013–2014 (n = 8017). Participants
903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures
Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results
Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014.
Background The level of demand on primary care continues to increase. Electronic or e-consultations enable patients to consult their GP online and have been promoted as having potential to improve access and efficiency.
Aim To evaluate whether an e-consultation system improves the ability of practice staff to manage workload and access.
Design and setting A qualitative interview study in general practices in the West of England that piloted an e-consultation system for 15 months during 2015 and 2016.
Method Practices were purposefully sampled by location and level of e-consultation use. Clinical, administrative, and management staff were recruited at each practice. Interviews were transcribed and analysed thematically.
Results Twenty-three interviews were carried out across six general practices. Routine e-consultations offered benefits for the practice because they could be completed without direct contact between GP and patient. However, most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making. This was perceived as adding to the workload and providing some patients with an alternative route into the appointment system. Although this was seen as offering some patient benefit, there appeared to be fewer benefits for the practices.
Conclusion The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system. The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.
NHS England has released a video case study in which a GP/Managing Partner at Larwood and Bawtry Primary Care Home in Nottinghamshire and South Yorkshire speaks about the impact of recently introducing online consultations in to his practice. This case study is one of a collection of ways to improve workload and improve care through working smarter, not harder.