A future picture of care outside hospitals where, alongside normal GP surgeries, patients have access to a new-style community-based resource equipped with diagnostic facilities, outreach specialist services and social services staff, is painted in the British Medical Association's (BMA's) submission to the Government's White Paper consultation YOUR HEALTH YOUR CARE YOUR SAY.
While preserving GP practice-based care for the majority of patients' needs, these new neighbourhood centres could also have other clinical services such as physiotherapy and dietetics, plus information on health conditions and advice for patients on how to manage their illness. On the social care side there could be staff offering advice on employment and welfare benefits as well.
The BMA response to the White Paper consultation says: "We see a key role for practice based commissioning in delivering these and other benefits. If properly implemented it could give groups of clinicians across sectors the ability to redesign services, establish more efficient care pathways, reduce referrals and offer patients a greater say and more choice in their journey through the system."
Planning the reorganisation of services would include not just GPs but doctors working in secondary care and in public health roles. All clinicians affected by service redesign should be involved. The BMA submission says the shift of work from hospitals to the community would need to be reflected in the training of junior doctors.
In its Executive Summary the BMA submission says: "The BMA sees considerable potential benefits for both patient and professionals in reforming care outside hospitals and in bringing more services currently provided in hospitals closer to the community. However, we also recognise that, to be most effective, many specialist services will have to remain in the hospital setting."
Access to GP Services
"We recognise that access to primary care services is a very real concern and that it needs to be improved in some parts of the country" says the BMA. Practical solutions are being explored with NHS Employers including "Dual Registration" where patients can register with both a home practice and one near their workplace.
Any dual registration arrangement must not be allowed to diminish the registered list system, says the BMA. This protects continuity of care that is an essential feature of the personal care given by family doctors - especially important to people with long term conditions.
Having given these caveats, the BMA states: "We share the public's desire to have more convenient access to a GP or health care professional both in terms of timeliness and in certain specific circumstances, for example near to a workplace, and believe we can offer a series of suggestions to help create resources to deliver this"
Private Providers in primary care
The potential risks and opportunities inherent in proposals to extent plurality of provision are finely balanced says the BMA. Patient services, education, training and research must not be harmed by increasing private provider provision. There should be a means of measuring the quality of new providers and a sharing of audit data and patient information. Most importantly there should be a level playing field with existing providers, taking full account of the value of general practice. "Resources should not be wasted on commissioning more expensive providers purely for the sake of involving the independent sector" says the Association.
"The BMA will take a forward-looking and constructive attitude to change but we urge the Government not to disrupt what is currently working well, so that we can build effectively on existing strengths."
In the coming weeks, the BMA's GPs committee will be sending posters and leaflets to practices all over the country setting out patients' views of how they value general practice.
The BMA's submission to the Government's White Paper consultation Your Health Your Care Your Say is accessible on the BMA's website at: CLICK HERE.
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