BMA: Quality and patients are key

As the government seeks to change the shape of general practice, Dr Nigel Watson of the British Medical Association (BMA) explains problems that need to be overcome and what he thinks needs to change.

"In the future we need high quality, patient-centred services that build on the strengths of general practice and address the weaknesses – and there are weaknesses in current practice.

"General practice faces a very uncertain future and many of my colleagues feel very nervous about where we are now and where we're going. One could be forgiven for thinking that the government and the media place little value on the current service and that radical reform is the only way of resolving this.

"If you look at UK general practice and the things that I think are important, they are that care is organised around a registered list; that as GPs we're responsible to the individual but we also have a responsibility to the community; that we have a lifelong medical record; we value continuity of care; we have knowledge of the family; we provide holistic care.

"The health service has been decimated into specialists who only deal with one particular thing and the only generalist that's left in terms of the doctors is the GP. We provide generally high quality at low cost."

Standards and quality

"So what are the problems? There is an unacceptable variation in quality, and the government, BMA and GPs would accept that. There are many high quality practices but there are some at the trailing end where the variation between the best and the worst is unacceptable and that is something that we need to address.

"I don't believe the government's current policies will do that. Tendering, commercial provision, the idea that you drive up quality, you drive down costs – that may happen in some commercial things, but I'm not sure it works that way in health.

"We must improve standards and the Royal College of General Practitioners and the GPC representing doctors and the BMA are ready and willing to meet the government and rise to that challenge to find ways to raise standards and make the best as good as it can be but also bring up the worst to an acceptable level."

Access

"Access is seen as our Achilles heel. We need to understand who we're talking about. Patients with long-term conditions who see their GPs frequently value continuity of care; they want to see a small number of healthcare professionals who know them, who they don't have to repeat the story to.

"So they generally have no problem getting appointments repeatedly. They value continuity; they value the list-based system.

"There is another group, who I'll call the citizens, who don't see GPs very often, they're not really bothered about continuity because they haven't got ongoing medical conditions, but they want to see somebody at the time and place of their convenience. And perhaps we don't deliver a service to them very well at times and we need to deliver a better service to both groups.

"But perhaps the second group need to understand that there is a trade-off between convenience and personal medical care. And what you might lose in a supermarket-style approach to health."

Competition

"The government believes practices aren't competing with each other and we need to do it more effectively. And the market philosophy dictates that competition drives down cost, increases quality and the customer is king.

"Well I don't think that necessarily works; I don't think that competition is necessarily what we need. What we need is practices that work together, clinicians to collaborate more and work to the benefit of patients and improve quality in every which we can.

"Why is the Department of Health so adamant that commercial companies are able to provide better care? I find that an interesting concept. But I do believe that commercial companies have a role to play and that is working in partnerships with traditional general practice and development and exciting things that can go forward.

"There is a place in the market for all of us – what we don't need to do is set up in competition and cut each other's throats."

The future

"So what's in the future? I think care will remain organised around patients and their needs; GPs will remain at the centre of it as the patient's advocate and the healthcare professional in the best position to take responsibility for providing, coordinating and signposting care to the appropriate service.

"We need quality improvement in areas where there are gaps between the best and the trailing edge and where that's marked.

"Managers and clinicians need to work to a common goal because 95 per cent of the agenda is common to us all – we're trying to put better services in for patients, not fighting with each other and finding divisive ways of just beating each other over the head.

"There's going to be a wider range and a greater range of services in the community. Practices working together more in collaboration.

"We need a national direction but we need local collectability. If we look at things like new large GP centres largely in many areas they're not wanted, they're not needed and they're poor value for money.

"If you gave us the concept and said 'how could you makes that work locally' we could do lots of exciting things with it.

"But actually giving national direction and rigidity with it, all it means is we'll invest a lot of money in something in some areas will be poor value for money.

"If the government really says 'we want local clinicians to lead it' then give us some freedom to do so, because at the moment it doesn't feel like that.

"We would like some genuine listening to patients. Patients are really important but what you've got to ask them is open questions, not leading questions that lead to an answer that you want, which happens all too often in health.

"I believe we need a real debate about where we're going and how we're going to get there. We need to build on the strengths of general practice in the UK and address the issues of quality.

"My message to the Department of Health if they'll listen is if you're really interested in improving general practice please work with us rather than entering into conflict with us because the patients will be the losers if we don't."