Shaping the future of London’s GP services
General practice is the bedrock of the NHS. Local GPs and their nurses are the first point of contact for us when we want help, advice or information about our health. 90 per cent of all patient contact with the NHS happens within general practice – that’s more than 300 million consultations every year!
The NHS is 65 this year, which is a reason to celebrate and be proud of this incredible health service. But times have changed and we also need to look at how we can improve general practice so that it can meet the demands of the 21st century.
Why does general practice need to change?
The last 65 years have seen dramatic changes to the way we live, work and communicate. London is changing. We have an ageing population, a surge in the number of long-term conditions such as diabetes, asthma and arthritis and GP practices must work within tighter budgets.
The sorts of problems affecting our health have also changed – the fact is the vast majority of patients that GPs and practice nurses treat today are unwell because of lifestyle choices such as drinking too much, smoking, a poor diet and lack of exercise.
General practice needs to respond to this new set of challenges and we are inviting you to get involved.
What are the challenges for general practice in London?
London’s growing population and increasing life expectancy has led to much greater demand for GPs, significantly increasing their workload. London has a relatively young population but still the most significant increase in age group in the next two decades will be the over 65s – set to increase by around 19 per cent by 2020.
GPs care for people from the cradle to the grave and they play an important role in preventing illness, diagnosing problems, treating diseases and helping patients manage long-term or chronic conditions. However, many Londoners find it difficult to get an appointment with a GP, let alone see the same one twice.
It’s not just GPs who are feeling the strain. The main reason given by non-urgent patients attending Accident and Emergency centres (A&Es) across London is that they can’t get an appointment with their GP. Providing consistent access to general practice services is seen as one of the key ways to reduce A&E demand but patients tell us they find it confusing to know which service is most suitable for them.
Financial pressures are forcing some GP practices to close and when patients are forced to go to A&E for treatment, the cost is significantly higher – a year of care by a GP costs just one tenth of a day’s stay in hospital. If we do not address this in a planned way we will see a steady erosion of the quality of care and patients will suffer.
How can we make it easier for you to access GP services?
Where you live matters
Over recent years, the quality of NHS services in London has improved significantly and, as a result, so has the overall health of the city. But whilst we have a longer life expectancy, there are some shocking variations and inequalities across the capital. For instance, research has shown that people living in more affluent boroughs can expect to live up to 17 years longer than people living in more deprived areas.
There are also big, unexplained variations in the quality of GP services across the city and patients register low levels of satisfaction in the services that their local surgery provides. For example, cancer referrals are lower in London than the rest of England with late diagnosis being a key factor in poorer cancer survival rates – 23 of the lowest 25 boroughs for breast screening coverage are in London. This must change.
What aspects of general practice care do you think need to change?
London is a vibrant city with a fast-moving population – more than 200,000 people come to or leave London each year. This means GP patient lists can be inaccurate, increasing workload and disrupting the continuity of care. More than 100 languages are spoken in London and more than 300,000 people living in London cannot speak English, obviously making patient consultations more challenging.
Different GP surgeries have different standards of care and services depending on where they are and how they are run. We believe every Londoner deserves the right to experience the very best care, wherever they live. In London, there are many small practices with just one GP operating in premises that are old, out-dated and run down. This restricts the services that these practices can offer.
What needs to be put in place to help general practice meet the needs of Londoners?
A vision for the future of general practice
We already have an idea of what Londoners want from general practice. We know that timely and convenient access is important. Patients with more complex physical and mental health needs want a service that provides consistent, continuous care, is seamless and supports them to stay well and out of hospital. The main areas for change are:
- To be more coordinated – working better with other health and care providers in social care, hospitals and mental health to provide the right services at the right time.
- To be more accessible – helping patients get the care they need at a time that is convenient to them.
- To be more proactive – taking a long-term view and helping Londoners to take control of their health and wellbeing.
Embracing new technologies
Our expectations of public services have changed dramatically in recent years. As a society, we are no longer happy to accept poor communication, poor customer service or a lack of information about the way things work. For example, lots of us now have online bank accounts and expect to manage our lives using new technologies, shop at the weekend and have more choice over goods and services. People want these things from healthcare, too, but general practice in London is not currently providing lots of services in the evenings or at weekends or able to deliver services using digital technology.
Examples of how technology could help improve access to GP services include being able to book, cancel or check an appointment, view medical records and order repeat prescriptions online using mobile technology. Being able to have a consultation with a doctor or nurse using email, phone or video would also allow people to be seen and treated without taking time off work.
Helping us to help ourselves
As the population ages, there is an increasing number of people living with multiple and complex long-term conditions. Patients with long-term conditions account for more than half of GP appointments and consume more than three quarters of the health and social care budget.
But there is more that could be done to help people take control of their own health and wellbeing. GPs and practice nurses have a vital role to play in helping us to help ourselves: from supporting campaigns on stopping smoking and eating more healthily, to giving patients, their families and carers access to information and education they need to manage conditions such as asthma and diabetes better.
We call this ‘self-care’ and research suggests that the NHS does not always recommend or support self-management when it would be the most appropriate form of care — placing avoidable strain on hospitals and patients alike.
In London, the concept of self-care has been slow to catch on and it is an area that general practice should promote in order to give patients and carers the freedom to take control of the way they manage their health.
How should general practice deliver care that is proactive about keeping people healthier?