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General practice needs new models: here are some ideas

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2460 (Published 06 June 2018) Cite this as: BMJ 2018;361:k2460
  1. Jennifer Richardson, features editor
  1. The BMJ
  1. jrichardson{at}bmj.com

Primary care in England needs innovation, says the King’s Fund in a new report—and it has scoured the UK and beyond for inspiration. Jennifer Richardson reports

New models of general practice could be essential to realise the potential of wider NHS changes in England, the King’s Fund argues in a report released on 7 June.1

In a project involving seven researchers, including three GPs or GP trainees, the think tank identified five characteristics that define general practice in England—and on which, it says, any new models must be based. Over the course of nine months the authors examined innovative primary care delivery models in the UK and internationally, classifying them into six approaches and identifying the six common features of those approaches.

The aim of Innovative Models of General Practice is to “offer insight for English general practice,” which the fund says needs new clinical delivery models—in addition to workforce and funding solutions—to meet the demands of a changing population, disease burdens, and public expectations.

“The pressures in general practice might be relieved by a reworking of the way care is delivered,” a King’s Fund spokesperson told The BMJ.

The essence of general practice

The five core attributes of general practice in England are, according to the report:

  • Person centred holistic care (“the core tenet of general practice”)

  • Accessibility

  • Coordination

  • Continuity, and

  • Community focus.

All five “must be present for general practice to deliver effective and comprehensive care,” the authors say, though “some may be more important for some patients and at particular times, and the balance between them may therefore change.”

They recognise the difficulties in developing a model that has all five elements. In particular, they highlight that a policy focus on access may be detrimental to person centred, holistic care—for example, “in the current model, increasing access while lengthening appointment …

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