Education And Debate Managing demand

Managing demand in general practice

BMJ 1998; 316 doi: (Published 20 June 1998) Cite this as: BMJ 1998;316:1895
  1. Stephen Gillam, director, primary care programme (,
  2. David Pencheon, consultant in public health medicineb
  1. aKing's Fund, London W1M 0AN,
  2. bInstitute of Public Health, University Forvie Site, Cambridge CB2 2SR
  1. Correspondence to: Mr Gillam

    This is the third of five articles on ways of managing demand for health care.

    Increasing patient expectations are placing strains on general medical services. While empirical evidence for increasing demand is difficult to establish, the population's use of primary care services has changed and will continue to change in response to demographic and technological pressures. Consultation rates have increased slightly over the past 10 years but out of hours calls have escalated more dramatically.

    Most chronic diseases can be managed with little recourse to specialist support, but patients are increasingly aware of diagnostic and therapeutic advances. The information revolution has fuelled demands for user friendly services of constantly improving quality across the public sector. Users seek appropriate information skilfully communicated by the health professional of their choice. Increasingly, people want to be involved in decisions about their management. The sense of a growing gap between what their patients want and what the service can afford provides a stressful undercurrent in the working lives of general practitioners.

    The advent of fundholding heralded a major shift of control over the allocation of health service resources to general practitioners. These powers are set to increase and with them new budgetary responsibilities. This paper analyses approaches to demand management which reflect both the changing relationship between general practitioners and their patients and the changing interface between primary and secondary care. With the development of more graduated pathways of access through the health system, these interfaces are blurring. How general practitioners manage needs expressed at first contact can influence patients' future self care; how they manage the interface with secondary care adds to pressure in this sector.

    Summary points

    The advent of primary care groups will involve all general practitioners in resource management

    Multifaceted approaches are required that affect demand at all points along the path …

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