The future of general practice?

In the last 12 months many have voiced their opinions on this contentious subject. Our new Prime Minister would like us to deliver a world-class service, 24 hours a day, 7 days a week. A senior surgeon last year revealed to a newspaper that he felt GP practices should be taken over by hospitals and GPs replaced with well-trained nurses, as the current service model was 'hopelessly outmoded'. A secretary would also be necessary, to write the (no doubt) many letters referring to private consultants (to ensure our patients have the very best opinions available). The RCGP quite naturally would like us to have a more prominent and appropriately resourced role.

The BMA has 34,773 members and they conducted a survey on the future of general practice. They received 15,560 responses - a rate of 44.6%. 71% of those who responded were principals or partners. This should give us a fair idea of where GPs think we are and where we may be heading.

When GPs are asked to rank the top three factors essential to general practice, the top answers that GPs ranked anywhere in their top three places are continuity of care (mentioned by 80%); trust and confidentiality between GP and patient (61%); holistic care (51%). We are obviously keen that these should continue. On their wish lists GPs ranked the following as important to providing their service: increased core general practice funding (76%); longer consultation times (70%); a reduction in bureaucracy (64%).

Over a third (37%) of GPs say that their practice has joined with a network or federation to form a new model of general practice provision. Popular reasons for joining other practices include: bidding for and delivering primary care contacts (mentioned by 43%), providing GPs with more influence on healthcare delivery (40%), and for long-term security of the practice by people part of a larger structure (39%).

Just under three quarters (73%) of GPs support the continuation of a national GMS contract. At the same time, just under half (47%) of GPs support the continuation of the option of a local PMS/Section 17c contract at some level, with slightly stronger levels of support in Scotland (51%) compared to England (47%). More than four in five (82%) GPs support maintaining the option of independent contractor status for GPs.

GPs were asked to rank the top factors that they find most attractive about general practice. The most popular reasons provided are: the variety of working as a generalist (80%); being able to develop relationships with patients over time (76%); having no weekend or night work unless they choose to (57%). Almost half (47%) of GPs would recommend a career in general practice to an undergraduate or a doctor in training.

When asked to rank the top factors that most negatively impact on their personal commitment to a career in general practice, the most frequently selected answers are: workload (71%); inappropriate and unresourced transfer of work into general practice (54%); insufficient time with each patient (43%).

A large majority of GPs (86%) agree that telephone consultations are an effective way of consulting with patients for appropriate reasons. Almost two thirds (63%) of GPs believe that telephone consultations can be an effective way of managing demand as an alternative to face-to-face consultations.

Most GPs voice concerns about the use of email consultations with patients. Seven in ten (71%) are concerned that using email consultations would increase their workload and almost two-thirds (63%) are worried about using email consultations due to concerns about clinical limitations.

GPs' concerns about the impact of video or web consultations appear to be less pronounced than they are over the use of email consultations. That said, more than half (56%) are still worried that introducing video or web consultations would increase their workload and half (50%) are concerned about the clinical limitations.

Only 2% of GPs agree that practices should offer seven-day opening access to patients in their own practices, and over nine in ten (94%) disagree. However, one in five (21%) GPs believe that practices should work in networks to offer seven-day opening to patients from shared sites.

Worryingly for the current model of practice, almost two thirds (64%) of salaried and locum GPs say they do not envisage looking for a GP partnership in the future. Only one in three (16%) envisage looking for a GP partnership at some point in the future (comprised of 20% who envisage doing so in less than five years, and a further 16% who envisage doing so in more than five years' time). One in four practice-employed salaried GPs (24%) envisage looking for a partnership in the next five years.

Certainly food for thought - but are the policy makers paying attention? And is political expediency compatible with common sense?