Answer: There is no evidence they actually work.
The Fuller Stocktake Report paints a bold vision to “to reimagine how we might deliver care in the future” and one of the key messages is Integrated Primary Care.
- Integrated Primary Care is a huge change and these are the questions we should be asking
Our current primary care system is based on the idea that you go to a generalist who covers the whole of medicine to a certain depth. That person can usually sort out what you need, then and there, and you can get on with your life. But there is obviously a limit to how much knowledge one person can have, and if they cannot sort the problem, then they refer you on to more specialised services in the community or in secondary care. The generalists are place based but the specialist teams are function based. Because you see the same group of generalists for all your problems you build up a relationship with them which improves trust and saves time.
Integrated Primary Care replaces this generalist with a multidisciplinary team where the generalists are merged with specialist community services and perhaps some secondary services to make a Neighbourhood team. This team covers up to 50,000 patients and your continuity relationship will be with this team. Care will be further divided up between a “single urgent care team “ seeing patients who need to be seen the same day and non urgent care delivered by other teams.
Replacing GP personal continuity with “Neighbourhood team based continuity” is like telling children to go home with the next available parent because it doesn’t matter who picks them up from school as long as they bring them back. And if there isn’t a parent available a babysitter will do.
- Is it unreasonable to require research showing non-inferiority compared to our existing primary care system before we make the change?
- Is it foolish, given the huge costs of the disruption this reorganisation will cause, to ask for evidence of significant gains which compensate?
- Is it impossible that the real reason Primary Care feels broken right now is because it has been battered by successive damaging reorganisations?
- Is it crazy to say that the reason no-one wants to be a GP is because the central NHS has wilfully tried to make the job awful?
The report does acknowledge that “Primary care has never been busier, and capacity gaps lie behind most of the challenges that the NHS faces”. However, the solution suggested is for staff roles “to be reimagined and made more flexible and attractive”. Also, a “rollout of innovative employment models such as joint appointments and rotational models” and an “integrated workforce solution, should be used throughout primary care to inform demand and capacity planning and enable team-based job planning and rostering to become the norm” will somehow make work lives better.
- Is it unjustified to ask for evidence that rotational models, team based rostering (etc.) make the work lives of GPs feel any better?
- Is it absurd to imagine that we might agree to all these changes and still find our workload is intolerable?
- Is it unwise to ask if we would get better outcomes for patients by spending the costs of implementing Integrated Primary Care on improving communication between existing function-based teams and employing clinicians to do more care? (especially since these reorganisations happen every 5 years so they are not a one-off cost)
So, what should GPs do? Go and look at the “factories” they want you to work in but don’t sell the “farm” yet.