On the evening of 28th February, immediately after the release of the National Audit Office damaging report on the 2003 GP contract, NAPC conducted a rapid response survey of practices, which sought to establish whether any new services had been established into practices, following the introduction of that contract.
A summary of the responses is set out below; some have been sent with a great sense of injustice:
* As a result of the introduction of the contract, systematic care for patients with chronic diseases, including recall systems, routine, regular check-up, have been introduced, which require additional nursing staff and data mangers (paid for out for new contract monies);
* Ultrasound; near patient testing and pre-work appointments at 8.30 am.
* Phlebotomy service; anti-coagulant service; improved telephone access, nurse triage and additional appointments (salaried GP working for 8 sessions)
* Obesity and weight reduction clinics; community investigation/diagnosis and management of LVF and DVT; diagnostic and treatment service for complex non-cancer skin lesions through dermatoscopy and biopsy; rapid access physiotherapy and musculoskeletal service; insulin conversion and management of complex diabetes with complications; in-house management of mental illness (without psychosis); CBT services; primary care counselling service; follow-up management of epilepsy; specific chronic disease management clinics with GPs and Nurse Practioners, which improve access for general and acute illness; rheumatology and joint injections services; daily and larger weekly multi-disciplinary team meetings to plan and co-ordinate the holistic care of patients with long-term illnesses, housebound and the terminally ill in a virtual ward.
* A few are: ECG; ambulatory blood pressure monitoring, practice based commissioning, additional diabetic, asthma and COPD clinics, CKD, Obesity and Depression monitoring as routine.
* No lunchtime breaks; practice is open from 8am to 6pm with telephone consultations and increased appointments to improve access; smoking cessation, weight management, healthy eating and exercise clinics as well as an increased number of COPD, CHD and asthma clinics; counselling clinics now provided at many levels, both general and specialist (for those with cancer); anti-coagulation; substance misuse and chiropody, dietician on site; diabetic chiropodist in practice for patients under 65 year; responsible for the management of violent patients across 18 practices; increased audits; data quality improvements; virtually paper free practice; increased minor surgery and Zoladex clinics; introduction of a minor injuries clinic; Choose and Book, Chlamydia screening; begun pilot for Information on Prescription.
* Complexity of primary care has increased with an increasing number of older patients developing multiple complex chronic conditions; simpler conditions managed by other members of the team, who have been recently recruited (and paid for by the practice); the practice now offers 15 minutes per patient and frequent review to manage multiple medical conditions and therapies effectively and safely in a patient centred environment, in a holistic manner; arrangements for monitoring patients’ treatment, tests and results have become systematised, with patients’ clinician reviewing results and taking an overview of patients care; many conditions have moved from secondary to primary care for ongoing follow-up, for example, the monitoring of inflammatory bowel problems, rheumatoid arthritis, psoriasis. Medical treatment is now frequently managed in primary care, with the GP being the only person aware of the entirety of a patient’s problems. Patients with mental health problems, including substance misuse are increasing in numbers and require substantial support and frequent contact, because of the need to address frequently co-existing problems. The management of these patients depends heavily on the quality of the relationship between doctors and patient and the level of trust which exists.
* Employ several salaried doctors, leading to more appointments and permitting other service developments.
* GP telephone consultations; test result nurse consultations; senior health care assistant post who delivers a phlebotomy service; optional home visits to new mothers; advocacy (language) services for baby and antenatal clinics; minor surgery; cryotherapy; IUCD insertion; yellow fever vaccinations; pharmacist medication review; anti-coagulant clinic; Chlamydia screening for under 25s; scanning of all letters in electronic medical records; health information portal for patients to view their medical records; hosting drugs and alcohol counselling; hosting psychological therapies services, including child psychologist; smoking cessation clinics, appointment reminders by text message; obesity management.
* Recruited three additional staff to provide consultations (two nurse practitioners and a salaried GP); hold a parent and child walk in surgery every morning; employ a practice pharmacist to assist patients with prescription problems and also now employ and additional healthcare assistant.
* Extended hours access; vastly increased numbers of nurse and GP appointments available; consistent provision of 24 hour access to GPs; increased minor surgery provision; extended range of in-house chronic disease management (for example, insulin initiation in practice, reducing the number of hospital visits; walking groups; weight management groups, increased advocacy provision; introduction of CAB and Family Welfare Association in-house services; in-house counselling; extended maternity services; in-house psychiatric clinic; massive range of local enhance services.
* Patients have noticed a comprehensive improvement year on year as can be evidenced from patient surveys.
Each * represents a response from one practice or a group of practices.
NAPC has a mixed membership of practices, PCTs and others from which volunteers provide a rapid response to topical issues by joining a syndicated e-mail system designed to produce comments/data and opinion on subjects of the day affecting healthcare and healthcare related matters.
Respondents are based throughout the NHS for a rounded and well-balanced view of events and include GPS, other clinicians, PCT and practice managers, as well as others working in or with primary care.
The process is to pose questions and invite responses within a very short timeframe. The answers to the questions are collated, graduated and evaluated into a unique snapshot of opinion, events, developments and trends in primary care.
The above snapshot of responses to NAPC’s latest topical survey identifies a substantial range of developments which have taken place in recent years; several have mentioned the increasing complexity of delivering primary care to both an ageing and younger population – the management of multiple chronic diseases; chlamydia screening and substance abuse clinics, for example. The changes being witnessed in ‘average general practice’ are significant and are accompanied by much greater systematisation. In leading edge general practice, the changes have transformed the care of patients over recent years, bringing routine management of many conditions out of secondary into primary care, accompanied by services provided by other bodies, which practices themselves have negotiated and introduced.
***ENDS***
Dr James Kingsland, Chairman NAPC 07887894124
Mr Mike Ramsden, CEO NAPC 020 7636 7228
Mr Roy Lilley, Independent Writer and Broadcaster 07831432111
