The blindingly obvious

It is widely accepted that General Practice is in crisis. A substantial increase in workload in recent years has not been matched by a commensurate growth in funding or workforce. Analysis by the Kings Fund (published in May this year) shows that consultations grew more than 15% between 2010/11 and 2014/15, but workforce growth did not keep pace. Face-to-face appointments are up by 13%, telephone consultations by 63% in the same period. To add to the misery funding fell from 8.3% to just over 7.9% over the five year period.

The report – ‘Understanding pressures in general practice’ – says:

‘Evidence suggests that people are finding it increasingly difficult to get GP appointments; politicians are pressing for extended opening hours; and surveys of GPs report low morale, unmanageable workload and problems with recruitment.’

So far, so obvious – we all know this.

Benfield Valley Healthcare Hub, like many practices across England, has experienced all these problems. The conventional approaches to managing demand have been used – from skill mix reviews to working with pharmacists; from telephone triage to workflow optimisation. Despite the improvements that have been made they seem to act only to stem the tide.

So far, so obvious – lots of practices have had the same experience.

So two weeks ago we started a piece of work with the aim to answer the question ‘how can the practice make a difference to the 7000 people in the community we serve?’

So far, so obvious – isn’t that what a general practice is supposed to do?

We are holding questions that may challenge some of the current conventions and, hopefully, will lead us to different solutions to what appear to be endemic problems.

Questions we’ll be asking

• Is demand really rising? As we have started to look we are noticing that a lot of the demand the practice services is of its own making, not because patients want or need to use the practice more or are inherently more acute or complex.
• Does access equal success, when viewed from a patient’s point of view? We are learning that getting in doesn’t always mean getting help. Sometimes we get it wrong. Often it takes us a long time to realise this.
• Are patient expectations rising? In our limited study so far, the expectations patients have are entirely reasonable at worst and often, in fact, quite low.
• Is our challenge really to become simply more efficient? Perhaps the real problem is that we believe efficiency is the challenge – forgetting that the real challenge is to become more effective. Ironically this confusion can make us less efficient.
• Is an ageing population really as big an issue as we are led to believe? Some data (such as this research published recently in the Washington Post) suggests not – and even so, we are learning that it is often our response to patients that is complex, not what they are presenting with.

The General Practice Forward View (published by NHS England in April this year) sets out a multi-billion pound view to address these conventional issues and to both stabilise and transform general practice. Our ambition is slightly less in terms of finances but no less ambitious in terms of scope.

Sharing the learning

We want to share with you, not just what we are experimenting with and doing differently, but why we are doing it and how we learned to think about it in that way – warts and all. We hope that you will join us as we learn.

We know we are likely to make mistakes. We’ll be open about this.

We know we might go down some rabbit holes. You can point these out for us.

We know that we might need help. We hope you will be able to offer this and be a shoulder for us to lean on if needed.

When a group of us were discussing what we were learning one of the GPs said:

‘Will we end up with a blindingly obvious conclusion? What we are talking about is GP training.’

Maybe we will. But if it is that obvious, the question then will be, why are we not already doing it?

You can follow Mark’s thoughts about the work we’re doing at Benfield Valley Healthcare Hub in his regular posts here and on Twitter (follow Mark on Twitter @markathere.)