The Roundhouse: an alternative model for primary care.

Abstract

The challenges facing health care are well known. They include an ageing population, increasing expectations, and shrinking budgets.1 GPs remain key in the provision of primary care in the current model and report that they are failing to cope with rising demand.1 Increasing concern that the 10-minute GP appointment is obsolete2 in the face of increasing comorbidity adds to these pressures. NHS England’s Five Year Forward View nevertheless emphasises that ‘The foundation of NHS care will remain list-based primary care.’ 3 It also reiterates the concept of redeploying care from secondary to primary, so-called ‘shift left’. This article presents an alternative model for delivering GP services. No single element of the model is new but the overall concept is revolutionary. The model’s integrity is key. It seeks to improve productivity through using the skills and knowledge of the GP to maximum effect while introducing a range of healthcare professionals to relieve the pressure of less complex care. The daily tasks of a modern GP would be instantly recognisable to their predecessor at the inception of the NHS in 1948. They are booked for most of the working day for face-to-face consultations with patients who ‘believe themselves to be ill’. What is different is the GP’s training and remuneration. In 1948 a GP’s training would have comprised 6 years. The modern GP has up to 11 years of training. Despite this, modern GPs continue to see ‘undifferentiated illness’. In addition, most personally type up patient notes (probably 2 hours of a GP’s day is spent typing [D Lewis, unpublished data, 2014]), and address all clinical decision making (100–200 laboratory results, 150– 200 prescribing queries, 50–100 incoming hospital letters, per GP per day.) The modern GP is relatively more highly paid than their 1948 counterpart. …