It has been a busy week with the publication, by NHS England, of the Urgent and Emergency Care Review and also the GP Contract for 2014/15. The role of GPs in providing prompt same day access was highlighted in both reports, forming part of a plan to ease some of the pressure currently faced by emergency departments and also addressing the desire to reduced unplanned admissions.
The GP contract included some significant changes including the removal of a number of QOF points and areas. The “headline” change would seem to be the enhanced service to reduce unplanned admissions and to provide proactive case management for patients identified by risk profiling. Specific ways to support this would be direct telephone access to a patient’s GP for Emergency Departments and Paramedics and improving same day access. In addition, all patients aged 75 years of age or older will have a named accountable GP who will co-ordinate their care and Practice boundaries will be removed. NHS England will co-ordinate urgent same day care for those patients registered away from their home. The push to harness the power of the internet continues and patients should have online access to their summary care record and be able to book online appointments and request medication (see the RGCP document Patient Online: The Road Map).
It is important to note that money is being recycled to enable these changes rather than new funding being directed to General Practice. Perhaps with this in mind, the RCGP have started a campaign “Put Patients First: Back General Practice” to campaign for additional resources. There is a lot interesting information in the campaign brief and you can sign receive updates either through Twitter or Facebook.
There will be a lot of changes in General Practice over the coming months, some of which will be very challenging. I think that as GP trainees it is important you consider how you would approach these challenges and what the pros and cons may be.
The RCGP annual conference took place this week in Harrogate against the backdrop of increasing media attention on seven day opening of GP surgeries. Earlier in the week the Prime Minister shared his vision for patients to have the “chance to visit a GP in the evening or at weekends”. Concerns have been raised about how the current GP workforce would be able to meet this demand when we are struggling to cope with the current workload. I wonder how, as GP trainees, you feel about the prospect of working significantly different hours to those you “signed up for” when you accepted your place on the GP training scheme?
Another controversial idea was that floated by Dr Clare Gerada with regards the independent contractor status of GPs. Dr Gerada has suggested that GPs should be “salaried to the NHS”. An interesting summary of the pros and cons can be found in a document Dr Gerada published in 2009 for the RCGP. I suspect this will continue to be a contentious topic of debate that, if it comes to pass, may have a bearing on your own professional plans as a GP trainee. What would you choose?
If you would like to see more then check out the videos of Jeremy Hunt and Dr Clare Gerada delivering their speeches at the conference.
Away from the conference, NICE have released “Diagnostic guidance” on the use of Faecal calprotectin. This is a test used to help differentiate between patients with irritable bowel syndrome and those with inflammatory bowel disease (Crohn’s disease and Ulcerative Colitis). On the surface of it this would seem to be a useful test for GPs who frequently see patients with bowel symptoms. I would recommend having a look at the guideline – even though I am not entirely certain if the test is available in Barnsley yet.
In April 2013 the NHS Commissioning Board produced a new direct enhanced service with the purpose of identifying, assessing and referring patients with a possible diagnosis of dementia. Paying GPs to undertake the new DES appears to be one of the key parts of the government’s approach to improving care for people with dementia.
It is not, however, without its critics. The lack of evidence to support screening for dementia and the pros and cons of an early diagnosis have been highlighted in recent weeks: BJGP and an interesting analysis from Dr Shibley Rahman.
Many of you will be working in GP Practices over the coming months that are taking part in this DES and it may be worthwhile thinking about the benefits and drawbacks for us as doctors, patients and society in general.
Further resources can be found here: DoH, NICE and RCGP. I would also like to thank Dr Samir Shah, Consultant Psychiatrist, for providing us with his top ten tips for GP trainees involved in caring for patients with dementia.