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Patients should be treated by admin staff and case managers - not always expect to see a GP, says think tank

The report calls for new models of working  - Credit: RayArt Graphics / Alamy Stock Photo
The report calls for new models of working - Credit: RayArt Graphics / Alamy Stock Photo

Patients should be treated by teams of administrative staff and case managers instead of expecting to routinely see a GP, a think tank has suggested. 

The King's Fund called for new models of working, as it warned that "general practice is in crisis" amid a shortage of 6,000 GPs.

It follows research which shows the average family doctor now works three and a half days a week, with 83 per cent of female GPs and 52 per cent of male GPs working part-time.

A study of trainee family doctors found just one in 20 intended to do the job on a full-time basis, a decade later. 

Today a new report by the King's Fund called for new ways of working to ease the growing crisis.

But it  suggests patients should not expect to keep seeing the same GP.

Report author Beccy Baird said: "We need to look at different models. It could be a 'microteam'  - where patients are assigned to a team, rather than to one GP, so that there is a nurse care manager, an admin worker and a care assistant doing much of the work, and the patient doesn't always have to see a GP."

Easing the amount of work GPs were expected to do in each session might mean they were prepared to take on more of them, she suggested.

The latest figures from a survey of more than 2,000 GPs show that on average GPs are working 3.7 half day sessions a week - a record low. 

The new report by the King's Fund says:  "General practice is in crisis," and says that family doctors are dealing with a rising and more complex workload, within the hours they work. 

"Funding has not been growing at the same rate as demand, leading to a profession under enormous strain and facing a recruitment and retention crisis," it says. 

The research calls for "new clinical delivery models" to meet demand, altering the way in which general practice operates and interacts with individuals, families and local communities.

This could include "micro-teams" - a shift away from the traditional "one to one patient-practitioner interaction," it suggests. 

Examining pilot schemes, the new report says: "Many models had created stronger relationships between professionals by moving away from the traditional one-to-one patient–practitioner interaction to a ‘micro-team’ approach, which involves a core team of professionals – for example, a GP, a nurse practitioner, a case manager, a medical or health care assistant and an administrator – working together to support a registered list of patients."

Such teams could mean patients got better access to care, and longer appointments when they were needed, it suggested, with continuity of care from a team, rather than any one individual. 

It follows recent research which shows that seeing the same doctor cuts the risk of dying early by up to 53 per cent, an international analysis has found.

Having repeated appointments with the same GP was as effective at reducing death rates as some drugs, according to an overview of 22 studies.

Lead author Sir Denis Pereira Gray, who led the work, said NHS policy needed a “complete change” in its policies to recognise the value of a personal relationship with a family doctor.

Earlier this year research found that being able to see the same GP is rarer than ever, despite Government pledges to improve continuity of care.

Five years ago, ministers pledged to bring back the “personal link” between patients and doctors, promising that all older patients should be given a named doctor.

It followed concern that large numbers of pensioners were ending up in hospital for lack of proper care from their GP, with vulnerable people seeing a succession of different medics.

But the study across the NHS shows that in fact, the chance of seeing the same GP has fallen by more than a quarter since 2012, with access to the same doctor worst among the elderly.

Researchers said the decline was “marked and widespread,” warning that lack of continuity is linked to admissions to hospitals, which are now at a record high.

The research published in the British Journal of General Practice tracked every GP practice in England which has more than one doctor.

Researchers from the University of Leicester found a sharp decline in the doctor-patient bond, across all socio-economic backgrounds.