Written evidence submitted by Dr Lawrence Brad (FGP0242)

 

I am a NHS GP partner and I have worked for 25 years . I have taught medical students , led on a NICE shared Learning Award ,worked with LMC GP education programmes, academic health science network ((including ePACT national data sets which won HSJ patient safety award)  ,  a clinical teaching fellow at a university department of pharmacology , I am a Q member Heath Foundation, RCGP fellow and representative for clinical pharmacists .

Dr L Brad FRCGP

 

 

Accessing general practice could benefit from an age banded and risk stratified process

If we could tailor the offering recognising mutually agreed systems rather than doing a one size fits all approach, I believe both patients and primary care teams might be happier. There are now so many interfaces that the current scattergun approach I believe does more harm than good.

 

A more digital approach without reference to a named GP might well suit younger healthier patients and integration for this group with community pharmacy services could make a lot of sense

At the other end of the spectrum complex frail older patients are probably best served by a named GP working closely with a frailty team.

The transition from one to the other will evolve with a robust system of risk stratification and high quality usable data that is individual patient identifiable ( e.g.   ePACT national polypharmacy data sets )

Challenges include

1.A significant challenge for the 5 years is optimising the transition from care from retiring GP partners to the care delivered by the multidisciplinary teams of tomorrow.

The Primary Care Workforce Commission document ‘The Future of Primary Care, Creating teams for tomorrow (2015) contained some excellent recommendations. However, in my opinion the need for creating learning organisations has either not been implemented, or at best poorly implemented. This is a problem and needs addressing urgently to facilitate this transition. In addition, this might provide a framework to retain highly experienced GPs that are retiring by developing formal mentorship and educational roles.

 

2. Developing a framework for the ‘Quantified Self ‘movement of patients with self-monitoring and self-care before and during diagnosis of disease. There is a risk of information overload that may be counterproductive to healthcare but of course exciting opportunities too.

 

3. Increasing the importance of evolving successful self-care , patient activation and a greater understanding of health seeking behaviour to help develop personalised care with risk stratification would appear to be underrated but essential

 

Bureaucracy and burnout

The incessant changes in requirements and processes for targets and onward referrals are the worst aspects of our job.

Interfaces seem to create friction where often minor details or omissions of information, that whilst explicable and laudable in principal, are not compatible with the intensity and pressure of work in frontline practice . Consistency and simplicity are often rare and data merging from existing information could be optimised better.

This is coupled with delegation of tasks from secondary care regularly causing inefficiencies and resentment to primary care teams.

Simple communication issues such as contacting and keeping continuity with consultants has remained difficult with little progress and admitting emergencies to hospital continues to be very time consuming and stressful.

The sheer volume of never ending multi interface tasks is a key contributor to burn out together with managing patient expectations. There are often potential conflicts when dealing with patients as opposed to citizens, and the well documented ‘Midlines’ approach to clinical decision making often feels uncomfortable and compromised which contributes further to stress. Clearer public health messaging (understood and agreed by clinicians) is often lacking and much needed to support our successful delivery of care

 

Simple optimisation of IT, from voice dictation systems to results management and improving clinical templates would appear to be low cost but highly effective for I improving efficiency and reducing stress.

 

Contracting / payment

Encouraging a personal GP list for risk stratified holistic care should attract a financial premium.

Multiple silo driven care creates poorer healthcare and increased burden of care and risk for patients. The shift away from continuity of care and towards transactional care is increasing and detrimental. Better supported primary care teams should strive for containment if possible, rather than increasing referrals. For example, simply having a link diagnostic consultant and having greater access to appropriate timely diagnostics would add great value to earlier diagnosis and efficiency.

 

Greater funding to recruit a range of co-workers from shared personal assistant roles, to mental health workers and social workers working in an integrated and collaborative way would be desirable.

Funding for developing learning organisations with protected learning time in teams and with protected time for mentorship would be essential to underpin all team development

 

Dec 2021