Rebecca Rosen: Transforming general practice

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Rebecca Rosen: Transforming general practice

  1. 1. © Nuffield TrustTransforming general practice:Setting the contextDr Rebecca RosenSenior FellowThe Nuffield TrustMay 15th 2013
  2. 2. © Nuffield TrustMultiple drivers of demandLack of accessto social careNewmedicaltechnologiesAgingpopulationsRising patientexpectationsRisingprevalence ofchronic diseaseNew providers/supply induceddemandPrimarycare
  3. 3. © Nuffield Trust
  4. 4. © Nuffield TrustRelentless rise in number of GP consultations
  5. 5. © Nuffield TrustChanges in workforce and working practicesKey findings from M&E surveyof GPs 2012.Majority work 8 – 9 sessions/weekIf working 2 sessions/day, > 10hrsBelieve quality remains high but workload is challenging thisWorkload  due to admin, QOF,LTCs and exceeding appt timesMany believe that more capacitywould help to  quality/  burnoutConcerns expressed about abilityto recruit GPs in futureMany report changing skill mix inresponse to increasing demand
  6. 6. © Nuffield TrustThe Primary Care Paradox....‘... a paradoxical situation: the tensionbetween the relative weakness and un-attractiveness of this level of care versus theintention to assign critical strategic functionsto it’From:Primary Care In The Driver’s Seat? Saltman, Rico and Boerma (eds) 2006
  7. 7. © Nuffield TrustPrimary care ‘fit for the future’Attributes• Comprehensive• Patient-centred• Co-ordinated• Continuous if required• Accessible• Safe and High Quality• Population focused•Adapted from Agency for HealthcareResearch and Quality 2013Sustainability• Financial• Workforce• Public trust• Fit with wider health system
  8. 8. © Nuffield TrustMechanisms for change• Innovation from within general practice• Extended scope and scale of primary and community based care• Payment systems and contracting arrangements• CCG initiatives to commission new services from primary care• Acute sector innovation• Hospitals setting up primary care services and integrated systems• Regulatory drivers of change• Competition rules driving CCGs into competitive procurements• New technology / information technology• Creating opportunities for new types of (rural) clinical encounter
  9. 9. © Nuffield TrustHow can new models of general practiceachieve these design principles?Two broad organisational arrangements emerging for GP:• Large partnerships• NetworksCommon challenges, including• Financial constraints• Uncertain regulatory context• Workforce pressures• New interface with commissionersNew opportunities, including• Clinical commissioning driving collaboration between practices• Policy focus on Integrated care• Changing expectations of general practitioners
  10. 10. © Nuffield TrustHostile policy context, no clear view of roleof primary care in national health system
  11. 11. © Nuffield Trustwww.nuffieldtrust.org.ukSign-up for our newsletterwww.nuffieldtrust.org.uk/newsletterFollow us on Twitter(http://twitter.com/NuffieldTrust)© Nuffield Trust

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