Professor Sir Sam Everington recommends that surgeons identify the most vulnerable people and then work in harmony with teams of social workers, health professionals and community volunteers to care for them. The general practice service has been described as the “beating heart of the NHS” but is under increasing pressure.
Every month, five million people can’t make an appointment when they want to. And millions more have to wait a month or longer before seeing a doctor.
But Professor Everington, knighted for his pioneering approach to treatment, says only a quarter of health problems require NHS intervention. The rest can be managed by changing factors such as lifestyle and environment.
He says that only five percent of patients – the most vulnerable – take up a disproportionate amount of GP time, requiring the involvement of a broad team of experts such as psychiatrists, physical therapists and pharmacists.
The British Medical Association said taking a broader approach to their care in the first place would reduce the number of people needing treatment from a doctor or hospital.
It will also free up GPs’ time for other patients.
Professor Everington also recommends that they have greater access to diagnostic tools.
Many of them now require a referral to a consultant, which increases the waiting time for patients.
Professor Everington, Chair of the NHS Tower Hamlets Clinical Commissioning Team, has a well-established team of health and care professionals who can help with issues ranging from psychiatric appointments to food delivery.
Creating a specific and more proactive care regimen for this vulnerable group will help prevent the need for inpatient care and even treatment in the first place, easing pressure on emergency services and the NHS, he said.
Describing how this works in his practice, Professor Everington said: “We call and see them regularly to help them deal with problems and potential problems.
“This could include food delivery, assistance from a physical therapist, psychiatrist, occupational therapist, social worker, geriatrician, palliative care nurse, or physician assistant. It may
prevent people needing access to their GP by providing services in the community.
“It can also prevent issues from escalating, which could prevent them from needing more NHS care.”
Expanding his vision for improvement, he encouraged general practitioners to perform the duties that consultants have, such as referral for diagnostic scans.
Professor Everington said this would allow family doctors to operate like “mini-hospitals”, offering more choice to patients and saving money. He compares them to small versions of the big supermarkets on the main street.
He said: “General practitioners should have direct access to many hospital diagnostic tools rather than going to consultants, which takes more time and money. It doesn’t make sense that we have to make so many referrals just to run diagnostic tests to justify your request.”
He added: “My message to the government, NHS England and the Department of Health is ‘Please think about the entire NHS system and how it can be used most effectively, not just hospitals.’
Professor Dame Claire Gerada, former president of the Royal College of General Practitioners, said: “The most vulnerable people need a system designed around them so that they need less specialized or hospital care. They have complex needs that many different people have to deal with, but the GP leaves all their care and it’s a mess.”
She added: “The National Health Service was created in 1948 for 20th century patients and most people now have 21st century problems. We train doctors in an outdated system, such as referrals to specialists.
“We have to look at the whole path of patient care. If you have diabetes, hypertension, and depression, you need a team to take care of your general medical needs, but most patients in hospitals wander around while GPs and doctors write letters to each other. This is nonsense. The system is too complex.”
The medics, who speak regularly to NHS England leaders, are also advocates for social assignment, which connects GP patients to support in their community, such as gardening.
This helps reduce unnecessary prescriptions and encourages patients to take control of their health.
Other experts we consulted for our Sunday Express investigation urged the government to allow practitioners to use resources more efficiently by allowing them to decide how to prioritize spending locally rather than relying on central funds.
Calls for change follow a scathing report from the Health and Social Protection Committee, which concluded that the “crisis” in general practice “puts patients at risk.”
“General practice is the beating heart of the NHS and when it fails, the NHS fails,” the report says.
Primary Health Care and Public Health Minister Neil O’Brien said: “Compared to before the pandemic, we have almost 2,300 more general practitioners and a record number are being trained. We also have 21,000 additional
general practitioners, including physiotherapists, paramedics and other specialists.
“In October, even without Covid injections, general practitioners had almost 14% more appointments than before the pandemic.
“The share of face-to-face meetings is back to pre-pandemic levels. General practitioners are doing more than ever before and doing more specialized work than ever before.”