GPs should be navigators not gatekeepers
- 24 March 2011
GP practices have been slow to adopt technologies that could transform the way patients interact with them, a major report into the quality of general practice has concluded.
There is also too much variation in performance between practices that could be addressed by more creative use and reporting of data, the 18 month inquiry into general practice by the King’s Fund has found.
The think-tank says general practice needs to adapt ‘significantly’ if it is to meet its new responsibilities and maintain its international reputation for excellence.
Its report says: “Overall general practice needs to deliver ‘post industrial’ care in which measuring performance, improving care standards and transparent reporting are key features of the way care is provided.”
The King’s Fund inquiry found that GPs face a range of challenges, including demographic change, higher patient expectations and new technology.
It says general practice needs to embrace technology in a way that allows it to match the experience of patients when they consume other services.
It argues that patients now expect the same benefits from technology that they see in other areas of their life, and that greater convenience could be provided by appointment booking, repeat prescription ordering, and record viewing.
The review also highlights the role of telehealth and telephone based care management systems for patients with long term conditions, such as Birmingham OwnHealth.
The says such developments could support self-management, save time for GPs and benefit patients who find it difficult to travel to the surgery.
“In most other industries, productivity has been driven by embracing new technology and harnessing the resources of the consumer," the report says.
"In this respect, general practice lags behind other service industries and has not yet exploited the enormous potential that technology offers for the patient to be a co-producer not only of health but also health care.”
Sir Ian Kennedy, who chaired the independent panel of experts who conducted the review, said: “General practice is the bedrock of the NHS and the profession is rightly proud of the contribution it makes to the health of the nation.
"But the environment in which it operates is changing and the profession must change with it.”
The inquiry also found that there were wide variations in the quality of diagnosis, referral rates and prescribing rates between clinicians and that GPs were often unaware of these variations.
It argues that GP commissioning could create a platform to drive improvements in quality and challenge poor performance, but while national data sets provide a rich source of information for measuring quality, they have significant gaps that need to be supplemented.
The report contends that a ‘virtuous circle’ of quality improvement should be created by combining external scrutiny with peer-led approaches, backed by transparency in the sharing of data at a local level with patients, the public and professional peers.
It calls on GPs to deliver a ‘new deal’ for patients and involve them much more closely in decisions about their care and performance.
“Meaningful engagement beyond those who have the time and inclination to attend open meetings will require practices to use technology and new media," it says.
The review strongly endorses the principle that GPs should be generalists rather than specialists.
However, it says that GPs will need to move from being gatekeepers to navigators; coordinating care for people with complex needs, signposting patients to other public services, and being held accountable for the quality of care provided.
Dr Laurence Buckman, chair of the BMA’s General Practitioner Committee, said quality was at the centre of what general practice offered and, no matter how good the service and care, all practices could improve.
He added: “We agree that GPs should be able to demonstrate the quality they offer to the public. However, as the report acknowledges, not all aspects of general practice work lend themselves to being measured easily.
"GPs have always been at the forefront in embracing new technology where it can make a difference to the way they provide care for their patients and, as the demands on the service continue to grow, practices will continue to adapt.”
Dr Buckman also said GPs “need time off the treadmill” so they can look critically at what they do and make improvements.
He said a reduction in bureaucracy would help them to do this, “as would stopping the constant reorganisations within the NHS."
The review commissioned ten research projects and four discussion papers and met 24 times over the review period.
Panel members were Sir Ian Kennedy, Dr Michael Dixon, chair of the NHS Alliance, former RCGP Council chairman Professor Steve Field, Professor Ursula Gallagher, professional executive committee chair and borough director at NHS Ealing, and Dr Rebecca Rosen, senior fellow at the Nuffield Trust.
