Image: GP and older patient. NHLT. Some rights reserved.
Named, accountable GPs for the elderly is one of a number of reforms Health Secretary Jeremy Hunt assures us will transform general practice. The proposal - made last autumn - had to be rolled out by the end of this June. But what difference has it made?
The launch last year generated positive headlines. The plans would revise the old-fashioned family practice, we were told. The government would also return GPs twenty-four-seven responsibility, comprehensive care packages. The plans would stop patients resorting to A&E, supply £400m additional resources, and free GPs from contractual administrative duties, all in order to bring about a new era of primary care.
The details of the new policy were set out in planning documents such as "Everyone Counts: Planning for Patients" and"Transforming Primary Care". These are important documents - the definitive guidelines for the management bodies of the restructured NHS.
"Transforming Primary Care" has rightly come under critical scrutiny. Jonathan Tomlinson in openDemocracy identifies named GPs for the elderly as one of the ‘gimmicks’ of a package that as a whole is out of touch with the real requirements of the system. Even in the normally government-friendly Kings Fund criticised "Everybody Counts" for failing ‘to give CCG leaders the clarity they will need.’
A brief look at the implementation of the named GP policy confirms that the critics’ suspicions are well-founded, and if anything understated.
A glance at the front-cover slogans of Everyone Counts demonstrates the hyperbole surrounding this policy review: "Better Outcomes for Patients", "NHS Services 7 Days a Week", "Transparency and Participation", "Putting Patients and Citizens in Control", "Transformative Ideas"…
"Everybody Counts" is plastered with empty rhetoric based on these headlines. It repeatedly emphasises that patients need to exercise positive choice. Not only are they to be empowered as "citizens and patients", the document elevates them to the status of "co-providers".
A crucial aspect of such empowerment related to the choice of medical attendant. "Transforming Primary Care" reminds registered practices that with respect to the choice of a named and accountable GP by the elderly, practices were expected to honour a patient’s "constitutional right to express a preference for a particular doctor within their GP practice and take a person’s preference into account in choosing named GPs."
The British Medical Association (BMA) cut through the rhetoric of NHS England. It assured its anxious members that any prospective additional responsibilities were in line with agreed contracts and existing work practices, and would not increase workload or significantly change GP habits. The BMA drafted a letter for GPs to send to their patients, headed "A new service for patients’" The letter - just five sentences long - adopted the narrowest remit, essentially instructs those affected that ‘Dr X will be your named GP’. It tells patients nothing about the intended horizons of the ‘new service’, and gives no indication that the patient might be involved in the choice of GP named to be responsible for their care.
When it came to action to meet the June 2014 deadline, practices were not obliged to use the BMA draft. Indeed they were given various options for informing their registered patients about the changes. In general the BMA formula was used, often with minor adjustments. In a minority of practices where the ‘personal list’ system was already in existence, elderly patients merely needed reminding that no change was entailed.
In general, apart from being assigned a named GP, the elderly are left by their GPs entirely in the dark about any benefits stemming from the new initiative. So far, these seem problematic. In most cases the elderly have been completely deprived of their constitutional right to express a preference. Patients are not told the criteria by which they have been assigned a particular doctor.
The elderly might have the good fortune to be assigned to a GP with whom they have long-standing relationship, but often the decision has been executed administratively, even distribution among partners according to alphabetical name order. The result may well be placement with a GP with whom the patient possesses no personal link, which is disruptive and possibly distressing to the frail elderly.
Even if the new arrangement is acceptable to the patient, what exactly is the nature of their relationship with their ‘named and accountable’ GP? Some practices indicate that in future the named GP should be the normal point of contact. Other practices stress that patients should continue to with their past habits and see other GPs as a matter of course. Given such ambiguous responsibility, the named GP might well fall out of the picture and neglected health issues will, as in the past, continue to be overlooked.
Although promoted as a flagship policy, in reality the named GP for the elderly policy is likely to be an ineffective gimmick.
The current policy documents issued by NHS England look like products of public relations machinery running out of control. A grandiose label does not a commitment deliver, whether it’s Better Outcomes for Patients, NHS Services 7 Days a Week, Transparency and Participation, Putting Patients and Citizens in Control, or Transformative Ideas.
At this stage of crisis in the NHS, we desperately need policies backed by scientific exposition, reflecting realities on the ground - not utopian fictions being peddled by experts in the art of the false prospectus.