How can we avoid the grim future for general practice?

Our NHS has been the envy of the world and a major factor has been the work of the GP, responsible for 90% of patient contacts, loved by patients and valued by professional colleagues.

To most people they represent the most accessible part of the NHS providing expert services with care and compassion. To specialists and managers they have been essential to the success of the health service by identifying patients who need specialist care, enabling the hospital service to function with fewer resources than comparable countries.

One of the key strengths is that GPs know their patients and the background knowledge and experience is highly valuable in assessing patients who present with a new problem. Every specialist knows the value of the past history and the time it can take to record it – for the traditional GP it’s in their memory already.

Managers have focused on the efficiency of the GP by planning to move more services out of hospital and into the community with inadequate funds following the patient. Many GPs now say their services are unsafe.

Patients may no longer have ‘their’ GP but will be allocated to a healthcare professional on the basis of their symptoms

And it’s likely to get worse. There are at least two substantial threats to the traditional and successful GP service – Accountable Care Organisations (ACOs) and online based GP alternatives.

ACOs operate in America, where one organisation contracts health services for the local population. In the UK, we have less money to spend and it is unclear how they will be accountable, what the quality of care will be and who will organise them – most probably accountants to ensure the books balance. Balancing the books means rationing services, by how much we have yet to learn but it will keep solicitors and accountants busy as they may operate under company law.

One feature is that patients may no longer have ‘their’ GP. They will be allocated to a healthcare professional on the basis of their symptoms – destroying the continuity of care vital to high quality GP work and in reducing hospital referrals. Large corporations will be circling like vultures around these huge contracts whereby they will seek to extract as much profit from them as possible.

Labour has now laid an Early Day Motion calling for a Parliamentary debate on proposed legislative changes to introduce ACOs. Without this, the changes could be slipped through Parliament with little scrutiny, risking a further lack of accountability in this whole process.

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