Report commissioned by King's Fund thinktank says GPs need to speed up referrals of patients with suspected stomach or oesophageal cancer
Many family doctors need to speed up the referral of seriously ill patients to specialists, sharpen prescribing of drugs and improve oversight of people with multiple and long-term health conditions, according to an independent inquiry into the quality of general practice in England.
The report of the inquiry – commissioned by the King's Fund thinktank and led by Sir Ian Kennedy, an expert on the law and ethics of medicine and chair of the Independent Parliamentary Standards Authority – calls for GP services to work on "an industrial scale". The report says that overall, patient care is good, but variations between practices are too wide and must be tackled by more sharing of information between doctors and other professionals to help them learn from each other.
The report calls for an acceleration of trends towards federations of GP practices and the presence of more specialists at GP surgeries. But it warns: "General practice will be able to deliver high-quality, cost-effective care only by operating on an industrial scale that makes full use of data and information to drive continuous quality improvements."
England has about 32,000 GPs and 72,000 practice staff across more than 8,200 practices. They will soon be responsible for handling £80bn of public money under NHS changes, but the report says "monitoring and transparency" of the quality of GPs are "underdeveloped and inconsistent".
Some GPs remain ambivalent "about the idea that they should continually and proactively seek new opportunities to improve", while much of general practice "might be characterised as being a 'cottage industry' in need of modernisation".
It adds: "For many GPs, quality improvement is seen as belonging to the domain of the professional manager and is pejoratively referred to as 'management speak'." Many practices remain "isolated … both in terms of their relationships with other practices and, more fundamentally, with the care and services that other health and social care organisations currently provide".
Examples of shortcomings listed in the report include a third of patients with stomach or oesophageal cancer being regarded as non-urgent referrals when they should have been treated as urgent cases; an eight-fold variation in the rate at which practices referred patients with suspected cancer symptoms; and the need for more efficient prescribing of drugs such as cholesterol-lowering statins.
The report says GPs should play a greater role in maternity services, have more confidence in dealing with patients nearing the end of their lives, and a take a stronger lead in the co-ordination of their care. They must play a more active part, too, in tackling in public health issues such as preventing obesity and reaching out to deprived communities.
ItThe report said GPs should play a greater role in maternity services, have more confidence in dealing with patients nearing the end of their lives, and take a stronger lead in the co-ordination of their care. They must play a more active part, too, in tackling in public health issues such as obesity and reaching out to deprived communities.
Kennedy said: "General practice is the bedrock of the NHS and the profession is rightly proud of the contribution it makes to the health of the nation. But the environment in which it operates is changing and the profession must change with it."
Chris Ham, chief executive of the King's Fund, said there was no room for complacency, even if general practice in England remained "the envy of the world".
"While many practices have been at the vanguard of innovation and quality improvement, too many GPs remain unaware of significant variations in performance and do not give priority to improving quality," he said.
The British Medical Association said patient satisfaction with GPs was increasing. Laurence Buckman, head of its GPs committee, said: "Increasingly practices are working more closely together meaning they will be able to offer the wider range of service that patients expect. However, we should not assume that bigger always means better. Many patients value smaller practices and, as they consistently perform well clinically, it is important that this choice remains."He insisted a culture of self-scrutiny had existed for many years.