GPs in the UK are offering group appointments of up to 15 people in an effort to cut waiting times and better support people living with long-term conditions like arthritis, diabetes, and asthma, family doctors say in a report in The Independent. Patients with conditions which require regular GP visits have taken part in group appointments which are extended to up to two hours and allow patients to support each other.
These can be led by nurses or administrative staff, with a doctor on hand for “around an hour”, to help save National Health Service (NHS) resources and minimise the time spent repeating information, the head of the Royal College of GPs (RCGP) said after the plans were announced at its annual conference.
According to the RCGP, the trials in London, Birmingham, Manchester, Sheffield, Newcastle and Berkshire have shown the schemes can be effective across a range of conditions. RCGP chair Professor Helen Stokes-Lampard said there was no suggestion these would be mandatory, or for discussing embarrassing conditions, but that they were likely to be part of the upcoming NHS 10-year plan.
She is quoted in the report as saying: “For some with long term conditions that need monitoring, support and follow up, there’s great evidence emerging of the benefit of a much longer consultation. These are 90 minutes or two hours – the GP is there for about an hour of that time – and everybody gets the chance to talk about their own issues. Sometimes being unwell can be a very lonely place, learning from colleagues and other patients – they become friends frequently – can be a very powerful way of realising other people are going through similar things.”
However patient groups have said the idea is “ghastly” and fundamentally undermines the notion of doctor-patient confidentiality.
Joyce Robins of the group Patient Concern added: “GP appointments are supposed to be a private matter where you can openly talk about your most personal health issues.
“If you’re discussing things in front of a group of strangers, you might as well tell the local town crier so he can shout it from the rooftops.”
In response, Stokes-Lampard insisted they would not be mandatory and participants would sign a non-disclosure agreement to take part.
The Patients Association said group consultations could be helpful to some people by providing an opportunity to have discussions about their conditions. Its CEO, Rachel Power, says: “It could also be reassuring to patients to see others share their concerns and challenges, and can provide the benefit of peer support. But patients must be given the choice as to whether to participate, or to continue with more traditional GP services.”
Doctors, MPs and campaigners in the UK have, meanwhile, hit out at the “creeping privatisation” of general practice, with private companies being handed contracts ahead of groups of GPs. The Guardian reports that they say that profit-driven firms are squeezing traditional GPs out of running family doctor services because of rules that NHS bosses and ministers both believe harm patient care.
They are demanding the repeal of parts of the coalition government’s controversial Health and Social Care Act 2012, so that NHS clinical commissioning groups (CCGs) are no longer forced to tender for any contract worth more than £615,000. Family doctors are angry that they must compete against commercial interests to run appointments in the evenings and at weekends, sessions provided to fulfil pledges to make the NHS a seven-day service.
According to the report, critics say the trend makes a mockery of declarations by ministers and the NHS England CEO, Simon Stevens, to seek closer collaboration between different parts of the service and reduce the role of private healthcare firms. Privately, NHS bosses say that their hands are tied, the law is “nonsense” and they have to allow for-profit firms to bid or risk facing legal challenge. Since 2016 Virgin Care has sued the NHS in Surrey as well as Lancashire county council amid disputes about contracts for services it failed to win.
The report says Hartlepool & Stockton Health, a not-for-profit GP collective that provides appointments at three Teesside surgeries, is a case in point. Despite high patient satisfaction scores and offering 25,000 extra appointments a year outside usual surgery hours, it could lose out to profit-driven companies. Several private firms, including IntraHealth, have expressed interest after it issued a tender worth up to £1.1m a year for the extended-hours service from 2019-21.
Dr Paul Williams, a local Labour MP who helped to set up the collective in 2015 and still practises as a GP, said: “The law is creating unnecessary privatisation that isn’t working in the interests of patients. This is a ridiculous fragmentation of services, at a time when the rhetoric from government and NHS leaders has all been about integration.”
The report says doctors’ leaders are demanding an end to outsourcing. “These services should be managed and run by local GPs working together. It is these doctors, who provide care to the same patients from within the community, that are best placed to control how the service works best,” said Richard Vautrey, chair of the British Medical Association’s GPs committee.
Other CCGs intending to invite bids for evening and weekend GP sessions include Bassetlaw in Nottinghamshire, Watford and Three Rivers in Hertfordshire. North Lincolnshire CCG has also invited expressions of interest in extended-access consultations at an urgent treatment centre based in Scunthorpe General Hospital worth £25m-£35m.
The report says private firms such as AT Medics have already won contracts for out-of-hours sessions. Last year, it secured a £1.5m, two-year contract from Camden CCG in north London; it does the same in other boroughs in the capital.
“The government is saying one thing – collaboration – but the reality is that competition prevails. How can it be better to have a private company running general practice for an hour and a half each day than having it run collectively by local GPs?” asked Williams.
The report says all 195 CCGs in England were required to have arranged extended-hours GP appointments for 100% of their population by 1 October. Such appointments were the centre-piece of David Cameron’s coalition government’s plans to turn the NHS into a 24/7 service.
[link url="https://www.independent.co.uk/news/health/gp-group-appointment-doctors-prescription-diabetes-back-pain-asthma-rcgp-a8571686.html"]The Independent report[/link]
[link url="https://www.theguardian.com/society/2018/oct/07/private-firms-take-over-extended-hours-gp-appointments"]The Guardian report[/link]