General practice: a vision for the future

Abstract

In association with With one in four patients admitted to secondary care with an existing nutritional problem (British Association for Parenteral and Enteral Nutrition (BAPEN), 2012), it is clear that the focus of any intervention could have been seen at a much earlier stage within the community. That said, hospital nutritional services have been the subject of drivers for improvement over recent years, with the appointment of nutrition teams, steering committees and pathways of care. However, with greater emphasis on continued reduction in hospital length of stay and acute care capacity, it is difficult to make inroads in the nutritional status of many hospitalised patients. It is, therefore, vital that resources are refocused on addressing malnutrition within the community. The ‘Managing Adult Malnutrition in the Community’ pathway can support general practice and community teams to assess and implement appropriate regimes of nutritional care. It is essential that we break down the medical model of care often seen within general practice and explore a more holistic approach to treatment. The medical model can often focus on short-term pharmacological interventions with little contact time to assess the broader context of health management. Over 15 million people living with chronic conditions receive a large proportion of their care out of hospital (Department of Health, 2013). This group could benefit from assessment and care that complements and enhances their medical treatment. The Royal College of General Practitioners acknowledges that, despite 90% of patient contacts being seen in general practice, it receives only 9% of NHS funding (Irish and Purvis, 2012). Therefore, it is understandable that a holistic care model is not easily integrated within general practice, especially when 85% of GPs feel the service is in crisis (Irish and Purvis, 2012). That said, the Care Quality Commission has appointed Professor Steve Field as the first-ever Chief Inspector of General Practitioners, who will be responsible for monitoring standards across GP practices in England. It is hoped that this will identify good general practice within a framework of openness and transparency for patients. Practice will be rated so that comparisons can be made by patients, with the aim of raising overall standards across the board. It may transpire that raising standards in general practice, supported by redirection of additional funding, may support patients in the community. This notion, if properly implemented, may see the decline in the continued rise in hospital admissions. The development of the malnutrition pathway can only support this process and hopefully lead to a reduction in the identification of malnutrition on admission to hospital. BJCN For more information, visit: www.malnutritionpathway.co.uk