Poorly planned policies could hasten decline of general practice in England

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Poorly planned government policies could hasten the decline of general practice in England, warns a doctor in The BMJ this week.

Stephen Gillam, a GP in Luton, calls on politicians to “heed experts on the front line, avoid populist gimmickry and follow through on promises to increase workforce numbers.”

Prime Minister David Cameron has promised seven day access to a GP if his party is re-elected next year, but exactly how this can be achieved against a backdrop of increasing workforce shortages is unclear, writes Gillam.

Extended access is only the latest in a series of schemes designed to “relieve pressure on hospitals” while assuaging the public’s supposed desire for limitless primary care, he says. Have any of them worked?

Evidence suggests that schemes such as NHS Direct and advanced access initiatives like telephone triage and email consultations have had little effect. One recent trial found that telephone triage led to redistribution rather than reduced workloads, while economic evaluations have found little difference in costs between triage and usual care.

Gillam even suggests that these schemes “may increase the burden on hospitals, especially if access to routine surgeries is compromised for work out-of hours.”

He also questions current pilot schemes to extend practice opening times funded by the Prime Minister’s £50m Challenge Fund. Where will the additional staff come from, he asks? Will hastening access lead to fragmented care, and does the public really understand the trade-offs involved?

The central problem is one of understanding, he argues. “Government ministers seem to believe that general practice exists solely to provide a filter for minor illness and to manage chronic disease in a manner that reduces the demands on expensive hospitals. In reality the distinction between acute and chronic conditions, and immediate and long term care, is blurred.”

GPs fear marginalisation by hospital-led bodies and further re-organisation, he adds.

The messages for both sides are clear, he concludes. “GPs must continue to adapt and innovate; they should not doubt the sincerity of politicians seeking to make primary care more responsive. Politicians should heed experts on the front line, avoid populist gimmickry, and follow through on promises to increase workforce numbers.”