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Primary care needs to move away from dependency on GPs as first point of contact, says expert

by Awil Mohamoud
21 October 2020

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Developing a comprehensive system of community care post-Covid-19 will require a ‘cultural shift’ away from the dependency on GPs as the first point of contact for patients, a former National Association of Primary Care (NAPC) president has suggested.

Speaking at the Management in Practice virtual festival this week (19 October) about reform in the health service, Professor James Kingsland said that a team-based care approach, designed around local needs, should be adopted going forward.

He said: ‘I think we’re seeing a gradual shift with resources being made available [to enable this change]. But local teams are saying the best way to develop our first contact care may be with a different range of health and social care professionals than those prescribed.’

He added that creating a functional primary care team means ‘getting relationships right’, creating ‘a consistent set of values’, and ensuring the people working together agree on the direction of travel – and not achieving this ‘could cause significant damage’.

A local approach

Professor Kingsland, who is an independent health advisor to the Isle of Man Government and a retired GP, went on to say that a series of issues need to be addressed following the pandemic.

He said that the ‘command and control’ approach from central Government at the start of Covid-19 had been understandable, but he had heard from some local areas that they now needed more control over the recovery response, in order to develop services based on local need.

Under this approach, teams will require access to information about what is happening in their local populations, and should focus on improving patient outcomes and commissioning the appropriate services to help make that happen, Professor Kingsland said.

He added that Covid-19 has also encouraged primary care to re-analyse it’s approach to leadership. ‘Everybody working in the health and social care system has qualities of leadership, but the question is, how do we make best use of that to enable them to lead their own practices on a daily basis, rather than being told what to do by the centre,’ he said.

Importance of planning ahead

Professor Kingsland also said that while Covid-19 could not have been anticipated, more time could have been spent on disaster planning, given the recurring nature of pandemics.

But a ‘bigger worry’, he added, was that the evidence from disaster management shows that the recovery phase often takes a lot longer than the response phase.

‘I’d suggest we’re still in the response phase at the moment, and there is more mortality in the recovery phase than there is in the response phase,’ he said.

‘This is not directly related to the pandemic, but instead the aftershocks of the delayed or deferred treatment, people not coming in for care, and the economic damage.’

The goal is for Covid-19 to go from being a pandemic to an endemic, he added, with the recognition that like the seasonal flu, the virus will be with us for the long-term.

The Management in Practice virtual festival runs until 18 November, with live sessions all this week.