Practices should offer patients an appointment within seven days and, if unable to do so, offer a slot with other practices, a think tank has said.
Conservative think tank Policy Exchange recommends the idea as a means of expanding choice and boosting access to primary care. It was included in a report aimed at the next Prime Minister, who will be announced on 5 September.
What do we want from the next Prime Minister? A series of policy ideas for new leadership: Health and Social Care contains 16 policy ideas – eight focused on the current pressures affecting access to services and eight that look to put the NHS on a sustainable longer-term footing.
It said that if a patient wants to see a preferred GP, they may be asked to wait longer than seven days in some instances.
And it said that in areas which are under-doctored, ‘patients will be offered the choice of an appointment with GPs or other primary care healthcare professionals based in neighbouring ICS geographies to meet the seven-day offer, using telephony or video consultation’.
The report said that this commitment would require some changes.
‘Delivery of this system will need to be underpinned by the seamless transfer of the patient record across primary care, and new reimbursement approaches to allow for neighbouring-area providers to reimburse for consultations.
Tying this together would be new metrics to assess patient experience in accessing and booking appointments – one area where there has been an alarming decline in patient satisfaction over the past 12 months,’ it explained.
The think tank also suggested community pharmacists could deliver ‘a greater proportion of ’ out of hours or weekend immunisations, where GP practices are unable to do so.
This would ease the workload in general practice, said the report, but it would need some changes to the current system.
It said this would be best achieved through a locally negotiated contract, which brings together qualified providers – general practice, pharmacy and local authorities – to collaborate rather compete against each other.
The report said that the deployment of the Covid vaccine demonstrated that pharmacies were a viable setting for activities such as immunisations. It recommended an exploration of opportunities to boost cooperative working between pharmacy and other providers, including improving data.
Other suggestions for stabilising primary care in the short term include the launch of a re-entry scheme to encourage retired GPs and nurses back into the workforce.
It also called for reform of NHS pension rules and their relationship with consumer price inflation.
The report said that changes to the interrelationship between consumer price index (CPI) and the annual allowance (AA) for public sector pensions could address the problem of GPs seeking early retirement.
It recommended that the new PM commissions an independent review of NHS pensions and their interactions with taxation policy. The review should commence in 2022 and report by January 2023 to inform the Spring Statement.
The think tank also recommended that action is taken to ‘transform’ the role of general practice within primary care.
It proposed a 10-year transition for general practice by introducing a new scaled model of integrated primary care in which workforce planning, estates development, data analytics and change management are supported by ICSs.
Relationship-based medicine and ‘continuity of care’ at practice-level should be supported through the growth of ‘integrated neighbourhood teams’ as envisaged in the Fuller Report, said the plan.
It said disparities, such as under-doctored areas, could be addressed by making contracting a more local process, with provider contracts negotiated and held with the relevant ICB.
These changes should be accompanied by ‘an improved and unified access route to primary care services called NHS Gateway, with standards and oversight from NHS England, but delivered and coordinated at system level’, said the report.
The manifesto also said that action would be required from the new PM ‘to avert a collapse of emergency care over winter’ and urgently free hospital bed capacity ahead of this winter.
That could be helped by investing more heavily in community care, it said.
‘The ‘least bad’ option will be to shift as much in-patient care to remote settings as is reasonable without compromising patient safety,’ said the report.
The report recommends a massive scaling up of virtual wards over this coming autumn and winter, to free up hospital beds and reduce bottlenecks in emergency departments.
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