The alleged crisis in GP recruitment is a political red herring. The bigger issue is the deep need for a change to the structure of commissioning, writes Andrew Haldenby, in a recent report from the right wing think tank ‘Reform’. He goes on to argue that access to general practice via new technology remains in a relative Stone Age. Only 7 per cent of people report that they have booked appointments online.
The current model of general practice is obsolete, it is true, and the Royal College of GPs knows this even if it is uncertain what to do about it. Calls for more funding for more GPs are just part of the NHS’s endless bidding war and not a serious strategy. But I think the problem is more than simply the size (meaning aggregate skills) of practices. Continuity of care, which matters for patients and for good practice, is best served in population groups of around 6000, or about 3 FTE GPs. The challenge for the large GP formations is to combine the back-office efficiency of large organisations with the clinical effectiveness of small work units. We will see how this tension is resolved as more large scale primary care organisations develop, but they will need independent investigation because the champions of large organisations – including the GPs driving them and the commentators (like Reform) promoting them – will be too biased to make sound judgements.
It is unhelpful to describe the technology of primary care as being in the ‘stone age’; and the choice of online appointment booking trivialises the issue. GP electronic medical records have led the way for creation of large clinical datasets and the introduction of real-time decision support tools. The datasets allow general practice to perform some of its public health functions, like risk assessment and stratification, whilst decision support tools enhance clinical expertise at patient level by standardising probabilistic reasoning. Where the uptake of new technologies is disappointing is in near-patient testing, particularly ultrasound, but even here there is progress in spirometry and oximetry, and in 24 hour blood pressure monitoring. We should not exaggerate the problems of general practice.