Primary Care Review

Why did we launch the review?

Patient interactions with GPs and primary care account for 90% of patient interactions with the NHS. GPs in particular are responsible for initial diagnoses and referrals to secondary care (which can only really be accessed through GP referral except in emergencies).

Since April 1st 2013 the structures of the UK health and social care system, especially in England, fundamentally changed. A greater focus was put on the role of clinicians in the provision of care, with the devolution of responsibility being redirected form the centre, to local and regional organisations under the oversight of the newly formed NHS Commissioning Board.

We agree that good health begins in our communities, rooted in a system of person centred care that promotes preventative care and understands the need to support individuals.  At the heart of the new system are the local health and care services people use on a daily basis – GP surgeries, home care, hospitals and care homes.

At the heart of these changes is a shift away from institutionalised, hospital based on a greater role for community and primary care. Family doctors, nurses, pharmacists and online/telephone services will have their role as the first port of call strengthened for those people I need. As well as providing patient care, in the new system, doctors, nurses and other professionals will use their knowledge of local health needs to commission the best available services to meet them. They do this by joining together to form Clinical Commissioning Groups (CCGs) who will have the freedom to commission services for their local community from any service provider which meets NHS standards and costs – these could be NHS hospitals, social enterprises, voluntary organisations or private sector providers. The aim of this is promote a more integrated system that will provide for better care for patients, designed with knowledge of local services and commissioned in response to their needs.

What are the issues?

The Patients Association Helpline regularly hears from patients who encounter issues when attempting to access, understand or seek referral from primary care facilities / professionals.  In 2011-2012 our largest single sources of contacts to our Helpline were about General Practitioners (GPs) with a quarter of all calls relating to issues with GPs relating to difficulties and / or complaints relating to:

  1. Communication issues with GP
  2. Issues with GP referrals and second opinion
  3. Issues with GPs removing patients from their lists without adequate reason or explanation

As the provisions of the Health and Social Care Act 2012 come into full force in April 2013, there remains a significant amount of confusion surrounding what Primary Care is, and what services are available to patients.

The continuing aim of the Primary Care Review will be to look into the main areas of concern to patients as informed by our Helpline and local engagement work.

Reports in the Primary Care Review Series:

Launched in September 2012, the Primary Care Review currently publishes as a bi-annual report on an issue of major concern to patients. The current reviews in the series are available for free download and an abstract of each publication is available below.

Sept 2012. Volume I: “Patients and GPs: Partners in Care?”

Our initial investigative report into the Primary Care Sector sought to understand the main areas of contention and frustration experienced and felt by patients. After surveying patients we found that the core issues related to:

  1. Communication
  2. Referrals
  3. Access (including Registration & De-registration)

The investigation also sought to understand the current status of the relationship between General Practitioners (GPs) and Patients in light of the changes that have occurred, and have been proposed in recent years.

March 2013. Volume II: “Access Denied?”

Since the publication of our original report in September 2012, our Helpline has continued to receive an increasing number of calls related to primary care issues.

Government reforms seek to build a new system upon the foundations of co-production, shared decision making and the ethos of “no decision about me without me”. However, if these concepts are to become more than just words, they will need to be supported by a knowledgeable and empowered patient able to understand and properly access the new NHS system.

Following on from our initial investigation, this report looked at how easy it is within the current system to access and understands the services available to patients under the current system, and highlights areas in need of review.

This report was also released with an accompanying technical supplement which can be downloaded here