Will the New Primary Care Model proposed by Simon Stevens resolve the crisis evident in General Practice?

Simon Stevens, the Chief Executive Officer of NHS England recently proposed an innovative new model of care which will integrate general practice and hospital services in order to provide more tailored, consistent and continuous patient care.

This new system would replace the traditional segregated approach to healthcare which saw gp services being provided independent of most specialist hospital services.

New model of Primary Care
The new model of primary care would include the establishment of a number of GP surgeries in hospitals. General Practitioners will also be encouraged to set up group practices serviced by both GPs and hospital consultants. This model could have a positive impact on healthcare as patients would receive holistic care because various specialists can deliberate on the right treatment to administer.

Moreover, NHS England has highlighted that the model would not be implemented using a national strategy as GPs in rural and urban areas would have the discretion to adopt and tailor the model to suit the needs of their patients. This is a wise move as one size fits all NHS strategies have not been successful in the past.

However, this new model could also bring about a number of challenges. Firstly, there is currently a noteworthy shortage of GPs. What’s more, over 500 surgeries may be closing as a large number of GPs will be retiring in the near future. This raises the question of where the NHS will find GPs to fill the roles required in the new hospital based surgeries.

Inadequate GP Staff
Additional questions also arise as to why the NHS isn’t training an adequate number of general practitioners to replace current doctors who will soon meet retirement age. One of the suggested reasons for the decline in general practitioners is that many medical students shun this area of medicine in favour of other specialities.

If this is the case, the NHS needs to implement initiatives that will incentivise medical students to become general practitioners. Perhaps additional medical students should also be trained as general practice is not the only speciality that is suffering due to shortages. It is evident that major changes are needed in the NHS to cope with the challenges that are currently being faced.

Insufficient Resources
Dr Maureen Baker, Chairman of the RCGP, stated that GPs do not have adequate resources to meet demands for patient care especially if we experience an aggressive winter. On a positive note, Simon Stevens has pledged supplementary primary care funds to cope with demand.

On the issue of resources, the question of whether the general practitioners will be responsible for managing the financial resources of the proposed GP surgeries is also important. It will be interesting to see how the management teams will be established and organised. There hasn’t been much mentioned in regards to the employment of business management professionals. While patient care is the main priority it is also important to ensure that healthcare is provided in a cost effective manner so as to minimise waste and maintain effective management of healthcare facilities to minimise the impact on taxpayers.

Current Environment
The government has proposed opening GP surgeries on evenings and weekends. If this initiative is implemented the new primary care model will have to cope with the demands of providing an extended service.

Moreover, there has already been significant negative feedback in regards to the new model. Many hospitals are not situated in central locations and patients are therefore concerned about how they will access the new surgeries. One of the benefits of current surgeries is the fact that they are situated in locations that are easily accessible to local residents.

It’s clear that major reforms are required in General Practice. The solution opposed by NHS Health is an innovative approach that may have a positive impact on healthcare as it will be delivered in a more integrated consistent manner. However, this new initiative will face a number of challenges during its implementation due to the climate it will be executed in; plagued by GP shortages, surgery closures and inadequate funding.

Doctors encouraged to opt out of EU directive and work longer hours. Are we heading back to square one?

The Working Time Regulations (WTR) implemented by the EU in 2009 has been subject to a lot of negative feedback recently. The directive, which limits doctors to working 48 hours per week has not been received well since it was implemented in 2009. However, of late, doctors have been proactively encouraged to opt out of the directive. There has even been talk of opting out of all the EU social and employment legislations in place currently.

Are we heading back to square one as junior doctors are encouraged to opt out of the EU directive and do longer shifts? That’s the question that’s on many of our minds. The reasons why the initiative was brought into effective in the first place should not be forgotten. Doctors were working over 100 hours per week which in turn had a negative impact on their performance. Tiredness and fatigue were a direct result of the excessive working hours.

Logically, one would think that reducing the number of hours worked would reduce fatigue and stress. Conversely, it’s been claimed that the reduced working hours have increased fatigue due to poorly organised rotas and shift patterns. An article in the Telegraph concurred that the new hours were exhausting to work and were unbalanced from week to week. But it appears that the problem is not the directive in place but rather the way in which it is being implemented. Perhaps better planning and organisation would resolve these problems, as opposed to encouraging doctors to start working long hours again which could be detrimental to patients.

Moreover, despite the fact that many of these articles give the impression that most junior doctors are unhappy about the directive, this may not be the case. The BBC highlighted a recent survey which found that 82% of young doctors struggle with the excessive hours they work. This was backed up by a piece written by a junior doctor in the Telegraph which highlighted that many doctors complained about falling asleep in theatre due to long, tiring shifts. The directive is therefore seen as a step in the right direction that has saved the lives of many patients.

A valid argument was put forward that less hours would mean that young doctors would not get as much training as they would if they were working longer hours. However, it appears that a key issue has not been taken into consideration. If doctors are too tired, are they really going to benefit from the additional training? This will leave us with poorly trained, burnt out doctors who will be more likely to make mistakes. Significantly increasing the number of hours worked is not the answer to this training issue. Better management of training schedules should be the main area of concern.

While there is the option to opt out of the directive, junior doctors should not be pressured into working more hours. They should be encouraged to make good judgements on whether they are physically able to take on additional work. The EU directive is in place to protect both, the doctors and the lives of the patients they treat.