Prudent healthcare: a GPs perspective

I believe that every individual in Wales has a responsibility to wisely utilise healthcare resources and to work together in partnership across boundaries, so as to enable their healthcare needs to be met and managed in a timely fashion. This include the individual’s need to look after, and optimise, one’s own general health and wellbeing through: eating sensibly, taking regular exercise, having regular dental and eye checks and engaging in screening and vaccination programmes.

Rather than talking generically about prudent healthcare, I wish to focus on the contribution that general practice already brings to this strategic priority of Welsh Government.

One of the most highly value aspects of general practice, in the context of prudent healthcare, is the trusted personal relationship that most patients have with their GP – and which I think most patients have. Without that relationship it is much more difficult to come to a shared understanding and agreement around prudent healthcare choices.

Let us not forget either that General Practitioners (GPs) are expert highly trained primary care specialists equipped to deal with undifferentiated health needs yet maintaining a holistic view of a patients needs. They are able to manage a wide range of problems from acute relatively minor conditions (e.g. acute infections) through to more complex problems. GPs enable this through their ability to use time efficiently; make decisions quickly; manage clinical risk as safely as possible in the best interests of their patients; enabling expert effective co-ordination of care across health and social care as well as through being prudent in their use of health service resources i.e. they appropriately make an intervention that will help the patient without exposing them to unnecessary tests or potential harm through inappropriate investigations (e.g. Radiation) or treatments (e.g. prudent use of antibiotics) and providing a gatekeeper role with referrals to specialist services.

General Practitioners offer a continuum of care from cradle to grave for its registered patients – offering continuity of chronic care management, quick access for acute or new problems and home visits for the housebound or terminally ill patient.

They offer high quality medicine as evidenced in the annual Quality & Outcome Framework monitoring figures, despite Wales having the highest burden of long term conditions compared with the rest of the UK, and the vast majority of this being managed within primary care.

Patients can access their GPs as often as they want which costs the Government a fixed fee of around £153 / year. Welsh patients consult their GP roughly 6.4 times per year this equates to a consultation fee of £24, which compares to £240 for a hospital appointment and £26 for a no intervention consultation with NHS Direct Wales.  It should also be noted that total consultations across Welsh general practice is in excess of 19 million per year and rising and the complexity of those consultations is also increasing.

Prescribing savings from prudent medicines management within general practice has led to significant offsetting of expenditure in other parts of the health service.

GPs are able to flex their services quickly should there be a need e.g. to better meet needs of its patient population OR, for example, in the event of a pandemic / major outbreak (e.g. action taken in the Measles outbreak in Swansea).

All of the above has been delivered by general practice despite there being a successive failure to expand general practice in line with successive Welsh Government policy commitments; an erosion of GMS funding since 2007 in terms of NHS Wales expenditure which has blighted the development of services; fragmentation of primary healthcare teams and an increasingly significant workforce recruitment / retention problem within Welsh General Practice.

Key themes running through studies into GP led services show that investment in this area is not only impacts positively on reducing inequalities of health but, critical to the prudent healthcare agenda, it demonstrates that this investment is an effective use of resources.  Thus, there are clear economic and clinical arguments for transferring more resource into primary care and, specifically, General Practice.  However, we must be realistic about what can be delivered in the current environment. GPs can not provide a Martini Service “Any time, Any place, Any where” and there are a number of significant challenges for Welsh Government to commit too in order to enable GPs to continue positively impacting on the prudent healthcare agenda.

GPC Wales has continued demonstrating leadership in highlighting the problems but also providing pragmatic practical solutions to the problems. These are wide ranging but critical if the prudent healthcare agenda is to succeed. There is not enough space to provide this detail here but in the Autumn the GPC Wales strategy document “General Practice: A prescription for a healthy future” will be published.

GPC Wales hopes that Welsh Government will enable General Practice to continue to positively impact on the prudent healthcare agenda. The solutions are theirs to give and the next year will be crucial to the sustainability of Welsh General Practice. We shall continue to constructively engage in discussions with Welsh Government and other key stakeholders, but shall have no hesitation in holding them to account should they fail to deliver!