Dr Clare Gerada, Chair of the Royal College of General Practitioners, argues that the GP’s role has never been more pivotal to the survival of the NHS:
General practitioners are critical to the success of the NHS; although figures vary, as a profession we undertake about 1 million consultations per day, which equates to around 90% of all NHS activity. And GPs refer only around one in twenty patients to specialists.
Their gatekeeper role means that GPs and their teams make the NHS safe, fair and value for money. However GPs do more than gatekeep to specialist services; they act as navigators and coordinators of care – roles that are becoming increasingly important as our patients become more complex and have more co-morbidities. It is not unusual for our patients to have four of five different long term conditions – be that hypertension, diabetes, depression, osteoporosis and dementia all combined in the same adult patient – or the multiple health, social care and family problems that are frequently encountered in children with long term disabilities.
It is the GPs, working with their registered patients in the context of their families, carers and communities, who enable continuity of care to be delivered. Continuity helps develop trust – and through this trust effective healthcare. Continuity helps to build relationships such that patients can feel comfortable in confiding their most intimate and troublesome details. And continuity, built up often from many consultations from infancy onwards, improves outcomes.
General practices and practitioners must however evolve and develop new ways of delivering care (for example, telehealth) and new relationships (through the formation of GP Federations working together with other practitioners in community settings). They must also develop new ways of addressing the needs of their high demand patients through risk stratification.
The NHS is going through difficult times at the moment. Every health care system in the world has to grapple with increasing demand and expectations against reduced finances in real terms. Health inflation is outstripping real inflation – a situation brought about predominately by improved technology, better medicines and new interventions. Only by investing in a generalist primary care work force, underpinned by effective and timely access to specialists and community services, can we deliver sustainable health care in the future.