Patients with multimorbidity need longer GP consultations, says RCGP

BMJ 2016; 355 doi: (Published 07 November 2016) Cite this as: BMJ 2016;355:i5961
  1. Jacqui Wise
  1. London

Patients with multiple long term conditions should have longer GP consultations to provide more time to discuss the complexities of their conditions, a new report from the Royal College of General Practitioners (RCGP) recommends.

The report, Responding to the Needs of Patients with Multimorbidity: a Vision for General Practice,1 says that patients with multiple long term conditions often have a worse experience of the health and social care system. This includes short consultations and care that is fragmented because of the disjointed approach of specialties and services that focus on specific diseases.

The number of patients with multiple long term conditions is increasing as a result of an ageing population but also because multimorbidity occurs earlier in deprived areas. An analysis by the RCGP estimates that the number of people with one or more serious long term conditions in the United Kingdom will increase by nearly a million to 9.1 million by 2025.

The report makes a number of recommendations, including developing multidisciplinary teams around general practice to ensure that GPs can get rapid access to the care their patients with multimorbidity need, such as mental health services, district nursing, and social care support.

It calls for improved communication at the interface of primary and secondary care to ensure that patient care is not fragmented. The report highlights a service in Leeds in which geriatricians meet monthly with district nurses, GPs, social workers, occupational therapists, and physiotherapists to improve the care of patients with multiple long term conditions. The service also has a nurse led patient care advice line that gives GPs access to speciality beds and advice from geriatricians.

The report also proposes improvements to IT systems throughout the whole health and social care sector to make collaboration easier between professionals and across different settings. Trainee doctors should also gain more experience of caring for patients with multimorbidity, and education should move away from the current approach of focusing on single diseases, it advises.

Another recommendation is for a review of performance related payments that relate to disease specific targets. It says that alternatives should be developed that encourage a whole person approach to care.

Maureen Baker, chair of the RCGP, said, “Currently, care is mostly channelled towards single disease conditions, resulting in a vast number of our patients receiving fragmented care. We need to tailor the services the NHS provides to better suit our patients’ changing needs.

“It is important that we support collaboration between GPs and our teams and specialists, and enable better communication between the primary and secondary care sectors by adopting improved IT systems.”


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