interviews

'Seven-day GP access will require an overhaul of how primary care works’

NHE speaks to Dr Ajit Kadirgamar, the co-founder of the country’s biggest independently run surgery network, The Practice group.

Primary care will need to be fundamentally restructured to deliver true seven-day access, according to Dr Ajit Kadirgamar, a GP for more than 20 years and clinical lead at The Practice group. He described to NHE a “perfect storm” of GPs leaving the profession, retirements, and fewer people choosing general practice as they exit medical school and said: “With the access we currently provide, [general practice] is already at full stretch, and we have some major recruitment and workforce issues. I can understand why people are concerned about seven-day access.”

Dr Kadirgamar has a good perspective on primary care via his role at The Practice group, which holds contracts for more than 50 GP surgeries and GP-led health centres, delivers more than 120 community outpatient clinics a week and sees in excess of one million patients per year. He said: “I don’t think we need access routinely, 24/7. We already have an out-of-hours GP service that operates in that way. We have urgent care access. We ought to be thinking about how we can make better use of that.

“Having new access alongside the current out-of-hours service is not tenable and would not be the best use of resources. But trialling it and seeing where the benefits are, and being outcomes-focused, and looking at improving or reproviding resources that are currently going into secondary and primary care, are probably the ways to address the resource issue.”

Workforce

Dr Kadirgamar said that while prime minister David Cameron’s seven-day pledge specifically said access to a ‘family doctor’, seven-day access will actually only be feasible if primary care is “restructured and delivered by a wider workforce”.

This will mean involving allied professionals more closely in primary care, including pharmacists, mental health professionals, health visitors, non-clinical care co-ordinators, and patients themselves via education about self-care and health promotion.

He added: “I can see the time coming where if you need to see somebody urgently for a primary care issue, you will go to the same centre that you go to for A&E, and unscheduled care is separated from GP in-hours care, where the more proactive, planned, long-term condition management type care happens.”

Out-of-hours versus A&E: perceptions and branding

Dr Kadirgamar was keen to talk about the state of existing out-of-hours services (discussed in more detail on page 21).

He said: “Generally, my impression is that what is being offered is a safe out-of-hours service. It does what it says on the tin: it offers a GP opinion about urgent things that can’t wait until the GP surgery is open the next day, and if it can wait is handed over safely into the next working day, when the in-hours GP can take over.

“But, if you don’t have access to the clinical record, it’s very difficult to do anything meaningful with it.”

He called that lack of access a “limiting factor” for out-of-hours services, and a “nut we have to crack”. “We have multiple clinical systems with the patient record. If you do have groups of practices working together, these systems can be accessed. It’s a model we currently use within our own organisations: practices are mostly on a single system, accessible from anywhere. That continuity of the medical record is what is going to offer the patients their continuity of care, because it’s going to be difficult, if not impossible, to make the same GP available every time a patient makes contact with primary care.”

Dr Kadirgamar compared how A&E is perceived by the public with how out-of-hours is perceived.

“The A&E brand is fantastic; it’s a brand that every patient understands, it’s somewhere near to where you live, it’s open all the time, there’s no paperwork, no registration, no barriers to access.

“General practice out-of-hours should be very similar. It’s very easy to get hold of, and you probably get seen by more experienced people and more quickly through general practice out-of-hours, but it’s not a brand that people understand so well. Even talking to my friends, they often [think that] if a GP surgery is closed, you need to go to A&E.

“We’ve not made that service very visible to the patient in the way that A&E is.”

‘Part of the NHS family’

Talking about The Practice Group itself, Dr Kadirgamar said: “We see ourselves very much as part of the NHS family. Myself and my partner Jeremy Rose came into this because we felt that we were looking to build the NHS and develop it so it moves in the direction it needs to for modern day healthcare. We have grown dramatically over the last 10 years, and we’re now at a scale where we’re keen to work in partnership. We want to start taking it a step beyond what we’ve been doing so far, which has largely been networking GP surgeries and running primary care specialist services in the community.”