nhs Managers.net Dr Clare Gerada RCGP

Without the right investment and infrastructure, general practice will not be able to be an effective provider and facilitator of integrated care or provide continuity

General practice as a driver of more cost effective care

In general practice, “generalism” makes little sense without continuity of care

Fragmented care Fragmentation results in providers caring for parts of a patient rather than the whole person Fragmentation is at the root of rising costs, poor quality of care & rising health inequalities

Continuity saves money 1% increase in proportion of patients able to see ‘their’ doctor associated with £20,000 cost saving for average practice/yr Chauhan M, Bankart JM, Labeit A, Baker R. Characteristics of general practices associated with numbers of elective admissions. Journal of Public Health. 2012; 34(4): 584–90. Hill A, Freeman G. Promoting continuity of care in general practice. London: Royal College of General Practitioners, areas/~/media/Files/Policy/A-Z%20policy/RCGP_ Continuity_of_Care.ashxwww.rcgp.org.uk/policy/rcgp-policy- areas/~/media/Files/Policy/A-Z%20policy/RCGP_ Continuity_of_Care.ashx

Continuity of Care Improves health outcomes Reduces costs Improves patient (and clinician) experience Reduces hospital admission Improves quality of care More personalised care Earlier diagnosis More effective care outside hospital Better use of medicines Better acceptance of self-limiting illness

Integrated care Best schemes are those led by GPs – backed by a team of other health and social care professionals with common objectives Review of literature found lower the input from GPs the worse the effectiveness of coordination of care and the number of referrals to the particular service concerned. To improve coordination of care need stronger links with secondary care – to improve transitions from hospital to home, and secure faster access to specialist knowledge.

Delivering Integrated care

Barriers to delivering effective general practice care Larger GP practices Part time working Access Loss of GP lists Multiplicity of providers Increase work load

Balance of work

Increasing & Changing Workload

Workload Between 1995 and 2008 the number of patient consultations in primary care rose by 75% The number of consultations per person per year rose from 3.9 (1995) to 5.5 (2008)

Workforce In a 12-month period from , consultant numbers rose by 3.5% FTE In the same period, GP numbers rose by just 0.2% FTE

Number of practice nurses vs total number of nurses

Change in average number of primary care consultations per patient per year,