By Dr José Garcia Lobera
In April this year it’s going be 15 years since I moved from Spain to work as a GP in Southend-on-Sea, very proudly in the same practice. Over this time I have seen the important role primary care plays in the lives – and the health – of local people and how reliant many have become on their local GP practice. That relationship between practice staff and patients is incredibly important and has become something patients trust to ensure their on-going health.
The General Practitioner has a pivotal role in the patient’s health and wellbeing therefore it is a figure that in many cases has become the default ‘go to’ position when patient have health needs in any way shape or form. The end result of this is that some patients who fall ill or have health concerns will want to see their local GP even when they could have been seen by other health or social care professionals. There are many occasions when GPs see patients who could have been seen by other health or social care professionals including pharmacists, social workers or mental health practitioners.
And this is something we are trying to move towards in order to better support our patients and ensure they are accessing the right services for their needs at the right time. This would bring many benefits to patients and professionals. Firstly of all, seeing the right professional within the appropriate specialism means a patient will be getting the very best care for their needs. It also means GPs will have more appointments available for patients who do need to see their doctor and access the skills and knowledge their GP can provide. We hope this new way of working will also better tackle related issues including health inequalities and isolation.
In mid and south Essex, GP practices are working increasingly closely with colleagues from across health and care services to deliver more joined care for patients. We are putting services in place within community settings and improving access to a range of different professionals so that patients are less likely to need to visit either their local hospital or their GP. This may include mental health therapists, pharmacists or social workers who are aligned to practices to help patients with more complex needs.
Working together helping patients to access services quicker and with the right professionals for their needs, whether they are urgent or non-urgent, we are building a responsive system that will ensure fewer patients reach a crisis point providing more proactive physical, mental and social care.
Hopefully it will also allow us to have more time to focus on mental and physical health and wellbeing ensuring we can put an emphasis on prevention and promoting self-care; we must empower patients to play a key role in protecting and improving their own health. We want to encourage them to make healthy choices and inspire them to be ‘health champions’ who lead by example, as well as taking a very active role choosing the appropriate treatment and managing their long-term conditions. We need to ensure this becomes a more central and routine part of everyone’s everyday life.
Longer term, I hope people will begin to see their local GP practice as a place of health and wellbeing rather than a place of illness. This is an important change that we need to make if we are to improve services for our patients and ensure the sustainability of local primary care services.
There are some good points about having an even more multidisciplinary team in general practice than there already is. In fact, this was certainly tried 30y ago when I was training, and I am all in favour of social workers, therapists etc being in GP practices. But really this STP move is a cover-up for long-term mismanagement of GP training and recruiting, especially in Essex. It is also an attempt to reduce access to GPs, thinking that will save money.
It can be very difficult, even with signposting, to know who is the best person to see in a team. Patients often have several overlapping concerns. Often things crop up in a consultation which the patient was not aware of, or had not linked together. A good GP is expert in looking widely and carefully at the whole picture, and can either pass a person on to a more specialised colleague, or pick something up and investigate it. It could take a lot longer to get the care you really need if we downcycle the GP service, as could easily happen.
Plans like this to save money have been tried often eg nurse practitioners. While many are very good, their training level is very variable, and they have never proved to be any cheaper than GPs as they need more time. Most GP practices do not have the space without investment to house a wider team. Nobody has the clout a GP has to get things done. they get listened to by other agencies and patients more. They are a combination of detective and active manager of health needs. We move away from the unique and much-admired GP system with considerable risk.
Why are NHSE not willing to provide funding for implementation of changes? They said “funds will have to come from SUHFT budget” So the hospital, alteady struggling with underfunding & demands to make even more savings, is somehow expected to fund primary care??
If NHSE are insisting on these plans being driven through for the benefit of patients and to improve outcomes, they need to provide sufficient funding to do it. I do not believe they are interested in anything except the establishment of ACOs. Government handing responsibility over to private sector, ending the NHS. Stop these ST plans please.
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I’m going to avoid funding and the national crisis. I applaud Dr Garcia Lobera for being in post at the same practice for 15 years. I’m currently concerned about the hospital reorganisation which is part of the whole process and whether it is clinically detrimental to the care of patients, particularly those who are seriously ill. Unfortunately I couldn’t place a link here for the evidence pack (clinical evidence for justifying new stroke service arrangements, etc), but would urge anyone scientifically trained who is interested in assessing them to lend a hand.