The Government should set up a 'transformation fund' to drive a seismic shift in general practice - to deliver better care for patients, enabling people to take more responsibility for their own health and utilise modern technology to access services remotely, according to a major new report.

The independent report, commissioned by the Royal College of General Practitioners (RCGP), calls for a revolution in the way general practice is delivered, moving away from the traditional 'cottage industry' model of small, relatively isolated surgeries towards an era where clinicians work differently with patients, and practices increasingly work together at scale - for example in federations - with other parts of the health service.

The report - An inquiry into patient centred care in the 21st century - calls for a new relationship between patients and clinicians.

It says this is needed to meet the diverging expectations of patients in the modern era, with many wishing to take advantage of rapid developments in IT to access to clinicians and to take more responsibility for their own care, and a growing number needing increased support due to the explosion of those with multiple long term conditions.

According to the report, the Government and NHS England urgently need to increase funding for general practice and wider community based care, following a decade throughout which investment in hospitals has grown while funding for general practice has fallen substantially, with just 8.5% of the NHS budget now going into the family doctor service.

The report states that, practices working together at scale could become 'multi-speciality community providers' which, as well as having GPs, would include specialists, pharmacists, social workers, community nurses and workers from the voluntary sector. This could enable them to:

  • Offer patients a wider range of clinical and community services
  • Raise standards of care
  • Merge back-office functions
  • Ensure high quality out of hours care
  • Offer a step-change in online access to clinical consultations and patient records.

The report, written by former NHS Confederation Chief Executive Mike Farrar and a team of 10 advisers from across the health care sector makes 46 recommendations, including calls for:

  • A move away from tick box clinical guidelines and performance indicators to an approach that recognises the need for care to be tailored to patients with complex conditions and rewards clinicians for respecting patients' preferences, instead of penalising them both financially and reputationally.
  • Implementation of NHS England's 'new deal for general practice', building on its key strengths including an easily accessible, local point of access; comprehensive services from a generalist clinician; continuity of care; and the registered patient list.
  • More resources and support for patient participation groups to help shape services and promote a culture change across primary care in which patients are equal partners with doctors, and
  • Action to ensure a substantial and sustained increase in GP training numbers, including incentives to attract trainees into under-doctored areas.

The report says that the current target culture in the NHS leads to patients sometimes getting the wrong type of care.

It says: 'Some patients are pushed into [treatments] that they do not want, while they are denied other forms of support they need'.

The report argues this situation is caused by the 'many guidelines in use in general practice that encourage GPs to recommend a particular intervention or medicine to patients with a specific condition'.

It adds: "In some cases, high levels of compliance have become a requirement of the regulator. In these circumstances, the GP is under considerable pressure to persuade a patient to accept a certain medicine or intervention."

The report also calls for a change in attitudes among clinicians across the entirety of the NHS.

It says: "The shift to delivering more proactive and patient-centred care within general practice is also in some instances being held back by traditional attitudes and behaviours in regard to care delivery.

"It will be vital to encourage and enable health professionals to provide holistic and personalised care, and to support patients to play an active role in managing their own health. This requires professionals to work with patients in a very different way, demanding new skills, knowledge and ways of thinking about the dynamics of power between professionals."

Commenting on the report, inquiry chair Mike Farrar said: "Given the pressures created by the age of austerity and the explosion in the number of people with more than one long term condition, it is imperative that the Government sets up a 'transformation fund' to drive forward a revolution in general practice and wider community care.

"We need a transformation in the way general practice is delivered, so that we can move away from the traditional 'cottage industry' model of small, stand-alone surgeries towards a new model under which practices increasingly work together at scale, with other parts of the health service.

"With an ageing population, changing public expectations and resources becoming increasingly scare it would be indefensible to continue delivering healthcare through models of care that were designed for the needs of a by-gone era.

"It is becoming increasingly clear that we need a seismic shift in the way care is delivered, as well in the attitudes of clinicians, to ensure we can provide care to patients that is centred on the individual and as close to home as possible."

RCGP Chair Maureen Baker said: "I welcome the work of this independent inquiry, which provides a strong endorsement of the pivotal role general practice plays while highlighting many of the pressures that GPs, and other health professionals, are currently facing.

"The sustained growth in the number of patients with more than one long term condition, coupled with the plummeting level of investment in community care, has left general practice, as we know it, withering on the vine.

"GPs across the country will embrace the call to adopt new ways of working in order to ensure better patient care, but - as this report highlights - this can only be delivered with far greater levels of investment in community care, and we call on the Government to act on this as a matter of urgency."

Dr Patricia Wilkie, President and Chair of the National Association for Patient Participation (N.A.P.P.) said:

"This is an important report that highlights the need for clinicians to respond to the clear desire of patients for an NHS that involves them as equal partners at every level in decisions that affect their care.

"We particularly support the report's call for the patient voice to be strengthened in primary care, and for Patient Partnership Groups (PPGs) to be given more resources and learning opportunities, so that they can work as effectively as possible with practices to improve care."

The inquiry, which was launched in June, received more than 80 written submissions from a range of organisations and individuals, and held discussions with more than 50 experts from healthcare, patient and charity sector organisations.

The inquiry panel comprised:

  • Mike Farrar, former Chief Executive of NHS Confederation (Chair)
  • Dr Patricia Wilkie, Honorary President and Chair, National Association for Patient Participation
  • Dr Rachel Carrell, Managing Director, Lloydspharmacy Online Doctor
  • Dr Anita Donley, Clinical Vice President, Royal College of Physicians
  • Hilary Garratt, Director of Nursing for Nurse Commissioning and Health Improvement, NHS England
  • Professor Chris Salisbury, Professor in Primary Health Care, University of Bristol
  • Rob Webster, Chief Executive, NHS Confederation
  • Dr Tim Wilson, Health Industries Consulting Lead Partner, PricewaterhouseCoopers
  • Professor Mayur Lakhani, Chair of West Leicestershire CCG, RCGP Council member and former RCGP Chair
  • Dr Andy Spooner, Commissioning Lead and Executive GP on South Cheshire CCG's governing body, RCGP Council Member, and
  • Dr Helen Stokes-Lampard, Honorary Treasurer, RCGP.

The full Inquiry into Patient Centred Care in the 21st Century report can be found here: http://www.rcgp.org.uk/policy/rcgp-policy-areas/inquiry-into-patient-centred-care-in-the-21st-century.aspx