The past year has been a success but we must not overlook the less tangible aspects of patient care, says Dr Matthew Lockyer
Just over a year ago, the nGMS contract introduced a system to reward practices financially for providing high quality patient care. Of the 1050 points available under the quality and outcomes framework, 550 are for gathering clinical data and achieving measurable outcomes in important disease areas.The remainder are for meeting non-clinical targets, for example in organisation and patient experience.
It used to be a frequent criticism that it was difficult to measure what GPs were doing. However, investment in IT, practice management and new staff to gather simple clinical data has enabled outcomes to be measured, and most practices have scored highly under the new system.
Some have claimed that targets were set too low, but it is rather, I believe, that the contract has enabled GPs to show how well they can provide structured, high quality care. Much of our work, however, is not so easily quantified. Explaining a diagnosis or a test result, or breaking bad news sympathetically can be as important as recording blood pressure or weight.
What changes have our patients noticed? Some will be aware of the increased emphasis on information gathering. I hope that we have become more active in changing their therapy to treat diabetes, heart disease and hypertension more aggressively. Many patients who were lost to routine follow up, for example those with epilepsy or who are taking lithium, have been invited for review. In our practice, everyone has worked as a team, and we have achieved a great deal. For example, we succeeded in encouraging almost all our patients with diabetes to attend for retinal screening. At the same visit, they underwent flu vaccination by the nurse and were weighed and measured by the healthcare assistant. Those who have been reluctant to attend clinic were offered an appointment with me there and then.
For many doctors and patients the most dramatic change has been in out-of-hours care.The nGMS contract allowed GPs to opt out of providing 24-hour cover for their patients and to end Saturday morning surgeries.
This was a bigger change for some practices than others. In our practice we have always provided our own cover, and we mounted an information campaign about the changes before handing responsibility to the PCT. Now, our duty doctor follows up the overnight cases with a phone call the next morning.
Handing over responsibility for out-of-hours care has improved our lives far more than we had expected, and our patients have accepted the new service with few complaints. In fact, the call out rate has dropped dramatically.
Canvassing patient opinion is included among the indicators of the quality and outcomes framework. In our patient survey, most of the negative comments concerned waiting times (a target under the nGMS contract), difficulty in making an appointment with the doctor of their choice and late-running surgeries.
The contract has made us look closely at matching service to demand. Now, 40% of our appointments are prebooked (a quarter of these are for such things as minor operations), and 60% are booked on the day or at the doctor’s discretion. This, together with ensuring that most doctors are present during the busiest times of the week, seems to have achieved a balance between our 48-hour access target and patients’ desire to book ahead. Our next patient survey will tell us if we have improved.
In future, patients will be offered a wider range of services in the community, by larger practices. My worry is that this may mean the end of continuity of care, which has been such a valuable feature of general practice.