New ways of working for general practice: A view from across the pond

There is increasing recognition that there will be (or already is) a shortage of general practitioners. To address this, there has been a focus on GP workforce by the government, Health Education England, NHS, and Royal Colleges. The reports and speeches have culminated in a Ten-Point Plan for the GP Workforce. Each of these ten logical points fall under the broad categories of recruit, retain, and return. However, there is one point – number eight – that does not easily fit under the three categories, even though it is the one that recruited me to Family Medicine, the specialty in the United States that most closely resembles general practice. 

Reform as a form of recruitment

Number eight in the Ten Point plan refers to 'new ways of working.' In combination, these four words represent a powerful movement, often co-led by the public and medical professionals, to change the way health care is delivered. Increasingly it is recognized by a variety of parties that the current model of care is no longer working. In his speech on the New Deal for General Practitioners, Secretary of State for Health Jeremy Hunt acknowledged that physicians are 'trapped on a daily hamster wheel of 10-minute appointments that lead inexorably to burnout, early retirement and unfilled vacancies.' Ten minutes is just too short to deliver life-changing diagnoses and effectively manage complicated medical cases.

As such, the promise and potential of 'new ways of working' can be what draws students into general practice. Studies in the U.S. repeatedly demonstrate that students choose primary care over other specialties when they value long-term quality relationships with patients. While I know of many GPs who have managed to establish strong relationships in spite of the short appointments, the trade-off is long waiting times for patients and long working hours for the physician. This is not sustainable. 

A new way of working

In the United States, the Affordable Care Act (more popularly known as Obamacare) strongly incentivized 'new ways of working' and provided a focus for the momentum building amongst medical professionals. This has led to widespread innovation and restructuring as medical practices clamour for the funding available under the new status of Patient Centered Medical Home (PCMH). These new models are very similar to the Multispecialty Community Provider Programmes being tested by the vanguard sites and give young general practitioners like me hope that we will be liberated from the 'daily hamster wheel' and allowed to develop meaningful partnerships with our patients. 

These models widen the roles of each member of support staff so that physicians can spend their time seeing complex patients. According to a report from the Primary Care Workforce Commission, GPs currently spend 11% of their time on administrative responsibilities. If a portion of this was undertaken by other medical professionals such as physician’s assistants or paramedics, this would result in a significant increase in the time physicians could devote to seeing patients. Similarly, expanded roles for pharmacists and nurses could ensure that this free time would be spent seeing medically complex patients. This is not to say that the burden should be shifted onto already overworked staff, but rather that the bottleneck of physicians could be relieved by recruiting other medical professionals to be part of a General Practice team. 

Another way of working: technology

'New ways of working' deserve more than one bullet point on the Ten Point Plan. Not only is it a recruitment strategy in itself, but it is a huge umbrella for the list of possible answers to the GP shortage. In addition to PCMH, other 'new ways of working' which need dedicated attention towards their development are those 'new ways' that involve technology. Physicians often ignore technology – myself included  – because there is an uncomfortable reality that in the near future various parts of our jobs will be made easier, more difficult, or even replaced, by technology. However, the market is not ignoring technology: many private firms are developing technologies that will directly respond to the demand created by GP shortages.

As such, there is a strong need for the medical community to be more open about the reality of encroaching technology; there is a need to embrace it and work with the public to ascertain the most valuable ways in which the technology can be incorporated. The Hippocratic Oath extends beyond immediate patient care and into future patient care; technology needs to be carefully curated to ensure that it does not become a barrier to the patient–doctor relationship, which is often just as important as the medicines prescribed.   

The future way of working

If successful, the 'new ways of working' will allow GPs to have longer appointments and more meaningful relationships with patients – one of the main reasons GPs choose their profession – while simultaneously reducing the current system’s reliance on physicians. In this manner, the 'new ways of working' will be tackling the issue of physician shortage from all directions. 'New ways of working' deserves to be a larger part of the conversation: what about our current model is working, what isn’t, and how can we move forward to a model that incorporates and promotes the best of general practice?

Sara Martin (@SaraMartin306) trained as a physician at Harvard Medical School and is currently working with the Policy Team at the Health Foundation