NHS England should introduce a ‘national measure of continuity of care’ to be reported quarterly by all GP practices by 2024, say leading MPs.
A new report into the ‘future of general practice’ published by the House of Commons health and social care committee today also called for the restoration of individual patient lists.
And it issued stark warnings of a demoralised profession, with GPs facing burnout from working in a ‘systemically toxic environment’, with unsustainable workloads, managing intensely complex cases at speed with fear over reprisals.
The committee – formerly led by new Chancellor Jeremy Hunt – said it had ‘extreme concerns’ over the decline in continuity of care and that reversing this should be an ‘explicit national priority’.
But the Government and NHS England have been reluctant to acknowledge the crisis in general practice and must do more to set out detailed steps to address this, it added.
The report said: ‘NHS England should introduce a national measure of continuity of care to be reported by all GP practices by 2024.
‘The new measure should be based on existing models such as the Usual Provider Continuity index and the St Leonard’s Index of Continuity of Care and in the short term should be based on measuring either continuity delivered by a named GP (in pooled list practices) or by a personal GP (in personal list practices).’
It added: ‘The measure should be reported quarterly at practice, Primary Care Network and Integrated Care System level as well as nationally.’
The report recommended an ambition for 80% of practices to return to personal list continuity by 2027, with personal lists in the GP contract from 2030.
Consideration should also be given to limiting patient list size to 2,500, moving to around 1,850 over five years as more GPs are recruited, it said.
Following a detailed enquiry led by then-chair and now Chancellor Jeremy Hunt, the committee recommended that ‘GPs should be treated like professionals and incentivised to provide relationship-based care for all patients’.
The report highlighted that in May this year, there were 27.5 million appointments in general practice – over two million more than in 2019 – but that while the number of registered patients has grown by 3.2% over the same period, the number of GPs working in the NHS had dropped.
‘It is time to recognise the need to make the job not just manageable but once again fulfilling and enjoyable’, with the professional status of GPs restored and ‘a decisive move away from micromanagement and short-staffing’, the committee concluded.
Health and social care committee member Rachael Maskell said: ‘Our inquiry has heard time and again the benefits of continuity of care to a patient with evidence linking it to reduced mortality and emergency admissions.
‘We find it unacceptable that this, one of the defining standards of general practice, has been allowed to erode and our report today sets out a series of measures to reverse that decline.
‘Seeing your GP should not be as random as booking an Uber with a driver you’re unlikely to see again.’
Professor Martin Marshall, chair of the Royal College of GPs, said: ‘Today’s report is long overdue recognition by influential MPs that general practice is in crisis and the Government must take note of its recommendations and act to address the intense workload and workforce pressures facing the profession as they strive to deliver care to patients.’
He added that urgent action was needed to recruit more GPs and retain experienced doctors in the profession longer.
He said: ‘The Committee’s report also acknowledges the importance of GPs and our teams building trusting relationships with patients and delivering continuity of care, something that evidence has shown improves patients’ health outcomes and has benefits for the NHS.
‘This is the type of care GPs want to give and the type of care many of our patients want, but amidst the current pressures facing general practice, is becoming increasingly difficult to deliver despite the best efforts of GP teams.’
The committee also found that the recent decision to introduce a two-week wait target for GP appointments will not address the fundamental capacity problem underpinning poor access.
And MPs said that the creation of primary care networks (PCNs) and the addition of new roles, while welcome, has not yet made a meaningful impact on the sustainability of general practice, the committee added.
Other recommendations include:
- The professional status of GPs should not be undermined by the inappropriate refusal of GP referral decisions
- A broader overhaul of primary care should include a dramatically simplified interface for patients who are often confused about whether to call the GP, out of hours, 111 or go to A&E
- A new funding mechanism should replace the Carr-Hill formula to better support access to general practice in areas of deprivation
- Urgent work is needed to stop a bidding war for the services of locums and encourage clinicians back into regular employment
- An additional 1,000 GP training places a year should be funded
- NHS England should take further steps to address the administrative workload in general practice
- Instead of hinting that it may scrap the partnership model, the Government should look to strengthen it because it is effective and efficient ‘if properly funded and supported’
- QOF and the Impact and Investment Framework (IIF) ‘have become tools of micromanagement’ which risk turning patients into numbers and should be scrapped.
This article was first published on our sister title Pulse
