Decline In General Practice Research Articles

A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data.

Despite patient preference and many known benefits, continuity of care is in decline in general practice. The most common method of measuring continuity is the Usual Provider of Care (UPC) index. This requires a number of appointments per patient and a relatively long timeframe for accuracy, reducing its applicability for day-to-day performance management. To describe the St Leonard's Index of Continuity of Care (SLICC) for measuring GP continuity regularly, and demonstrate how it has been used in service in general practice. Analysis of appointment audit data from 2016-2017 in a general practice with 8823-9409 patients and seven part-time partners, in Exeter, UK. The percentage of face-to-face appointments for patients on each doctor's list, with the patient's personal doctor (the SLICC), was calculated monthly. The SLICC for different demographic groupings of patients (for example, sex and frequency of attendance) was compared. The UPC index over the 2 years was also calculated, allowing comparisons between indices. In the 2-year study period, there were 35 622 GP face-to-face appointments; 1.96 per patient per year. Overall, 51.7% (95% confidence interval = 51.2 to 52.2) of GP appointments were with the patients' personal doctor. Patients aged ≥65 years had a higher level of continuity with 64.9% of appointments being with their personal doctor. The mean whole-practice UPC score was 0.61 (standard deviation 0.23), with 'usual provider' being the personal GP for 52.8% and a trainee or locum for 8.1% of patients. This method could provide working GPs with a simple way to track continuity of care and inform practice management and decision making.

Put more money into general practice to protect patient services, say GPs

A greater proportion of the NHS budget must go into general practice to protect services for patients, GPs have said. Delegates at the BMA’s local medical committee (LMC) conference in York this week unanimously supported a motion saying that there would “no longer be a sustainable NHS unless the decline in general practice is urgently addressed.” The motion said that “general practice is the most cost effective part of the NHS” and demanded …

From professional to sub-contractor – the swift decline of general practice: rejoinder to Watts and Pinskier

From professional to sub-contractor – the swift decline of general practice: rejoinder to Watts and Pinskier

Medibank and the decline of general practice.

Medibank and the decline of general practice.

Public Policy and the Supply of Primary Care Physicians

The decline in general practice, the arrested growth of family medicine training programs, and the increased subspecialization of internal medicine and pediatrics are responsible for the continuing decrease in the proportion of physicians in the United States who practice a primary care specialty. Since 1963, the number of physicians has more than doubled, but the ratio of office-based primary care physicians to the national population has decreased. This trend has been especially pronounced in rural areas and impoverished urban communities. There is evidence that the proportion of young physicians entering primary care specialties is declining. Medical education has become increasingly reliant on service income, making it difficult to fund training in primary care specialties. Grants for graduate training in primary care specialties have not increased with inflation, and outright elimination of these programs is under consideration. Public programs that fund medical education must be reformed to improve the geographic and specialty distribution of physicians.

Family practice: quality and credibility.

The decline of general practice as an acceptable mode of medical-care delivery began with the publication of the Flexner Report. This decline was further accelerated by the emergence of the specialty boards in the 1930's. Because of increasing doubts concerning the competence and qualifications of general practitioners, the rapid development of subspecialties and the geometric increase in medical knowledge, the decades after World War II almost killed general practice. The passing of the family physician was a real and distinct possibility. The decline was slowed by the emergence of the American Academy of General Practice in 1948. Reversal of the . . .

The emergence of the family practitioner

The family practitioner evolved as a specialist to replace the rapidly disappearing general practitioner. The lack of adequate postdoctoral medical education programs for general practitioners, the changing role of the general practitioner in relation to the specialist, and the lower status and different working conditions of the general practitioner compared with the specialist contributed to the decline of general practice. Those who attempted to develop the specialty of family practice actively sought to remedy the deficiencies of general practice by providing intellectually rigorous postgraduate programs, by providing a unique area of expertise, and by providing specialty status.

The Decline of General Practice: Addendum to Report of Millis Commission

The Decline of General Practice: Addendum to Report of Millis Commission

The Training of the Internist: Today and Tomorrow

If one out of six of our medical-school graduates were unable to pass his state board examination, there would be great alarm. The fact that almost this many young physicians, having completed acceptable training in internal medicine, are unable, even after several attempts, to pass the examination by the American Board of Internal Medicine should be cause for concern. This fact in itself may have several possible explanations, but I bring it up as only one of the reasons why we should take a fresh, new look at training in internal medicine. In the changing scene of medicine I believe that it is high time we review our methods and goals. With the decline in general practice in the classic and broad sense, there has been a reciprocal rise in specialism in the United States (Fig 1). To me the most impressive fact is the rapid increase in the number

Etiology of Decline in General Practice

MY TASK is not to make a diagnosis. That has been done by others more experienced than I.1,2Decline in general practice is a fact. It is more difficult, however, to determine the etiology of this decline. In the history of knowledge of causes of disease, we have moved a long way from the era of one cause for each illness. While the pneumococcus is indeed a cause of pneumonia, its entry into the lung is sometimes preceded by an acute alcoholic bout resulting from many factors, known and unknown—physiologic, social, and psychologic—in the patient's background. So it is in the etiology of the decline of general practice—the concept of multiple rather than unitary causation must be invoked. Most of us have our pet theory as to the cause of this decline. The figure on the following page illustrates the clear association between decline in per cent of physicians

Etiology of decline in general practice.

MY TASK is not to make a diagnosis. That has been done by others more experienced than I.1,2Decline in general practice is a fact. It is more difficult, however, to determine the etiology of this decline. In the history of knowledge of causes of disease, we have moved a long way from the era of one cause for each illness. While the pneumococcus is indeed a cause of pneumonia, its entry into the lung is sometimes preceded by an acute alcoholic bout resulting from many factors, known and unknown—physiologic, social, and psychologic—in the patient's background. So it is in the etiology of the decline of general practice—the concept of multiple rather than unitary causation must be invoked. Most of us have our pet theory as to the cause of this decline. The figure on the following page illustrates the clear association between decline in per cent of physicians