The Future of GP Collaborative Working
One of the greatest challenges facing the health service is how to respond to the changing needs of patients, within organisational confines that have not adapted to keep pace with these changing demands. The population of the UK is living longer and longer and consequently, the number and type of conditions seen within the health service is increasing not just in number but in complexity.
Many patients seen within general practice are suffering from multiple coexisting conditions of varying severity and complexity. In order to give these patients the care that they need, the health service must move away from the management of single disease conditions towards an understanding of how living with multimorbidity impacts on patients’ health. This requires concurrent and integrated treatment by a number of different disciplines that are fundamental to a patient’s good health – paediatrics, physicians, social care, psychiatry, and pharmacy – with the GP as the expert medical generalist at the centre of this process.
Integrated working can take many forms, from the physical integration of services - clinicians working at scale within specifically designed services, or within multidisciplinary teams in both a primary and secondary care setting - to virtual integration - the sharing of records and communication between different aspects of the health service.
This paper brings together case study examples of GPs taking the initiative and working in an integrated fashion, alongside secondary care physicians and the wider health and social care system, in order to redesign services to better meet the needs of their patients. The examples given show how it is possible to take advantage of the opportunities available and work within existing frameworks to create a service that responds flexibly to patients’ changing needs.
However, in order for clinicians to be incentivised to take these opportunities, consideration must be given to the challenges faced by GPs and other clinicians, both in changing their way of working, and everyday practice. The redesign of services is dependent on support or ‘buy in’ from local commissioners, providers and health authorities. In some cases this can be hard to achieve and maintain, leading to services being ‘let go’ over a period of time. In addition, many of the case studies cited the lack of available resources (both funding and staffing) as a significant barrier to the continuation of their service.
Despite the governments of the of the UK committing to build a more integrated health and social care system, there are serious concerns around the ability of legislation to deliver the change needed, with many government initiatives failing to take into account the central role of the GP in delivering patient care, and additional funding often falling far short of what is needed. These longstanding issues must be resolved, with legislation and funding levels built around the aspirations of GPs and the wider health service to provide the long term collaborative care that patients need.