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The Future of Primary Healthcare in the UK: a GP Practice, but not as we Know it

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A few years ago, a friend of mine told me about a recent appointment he’d had at a high street bank. Self-employed, his business was doing well and he wanted to buy a new home. He couldn’t afford to do so without the help of a mortgage, but, despite his earnings being far more than was needed to support his mortgage needs the bank declined his application.

“As soon as I explained that I was self-employed, the bank didn’t want to know,” my friend explained. “The mortgage advisor – who looked like he was only just out of nappies – told me I was too big a risk. I asked him why he thought he, being employed, would be less of a risk. ‘Because I have a stable job,’ he told me.” My friend laughed.

“I tried to explain to him than my earnings were probably more certain than his. I told him that, having a number of clients, if one of my clients pulled out or cut the work they gave me, I could still easily survive. ‘You’ve got one client,’ I said to him. ‘The bank is your client. If you lose your job, that’s it. You lose 100% of your earnings’.” He laughed again. “Three months later I bumped into him looking in a job agency’s window. He’d been made redundant, and was trying to survive on job seeker’s allowance.”

Should GP practices start searching for new ways of working?

I was reminded of my friend’s story when reading a recent article in HSJ. It asks if general practice might only have five years left to live. An Ockham Healthcare survey found that a third of GPs think it unlikely or very unlikely that they would be providing GP services in 2020. There is a whole raft of problems facing GP practices that are fast becoming insurmountable, including:

- Demand is up

- Costs are up

- Income is down

- GPs are becoming near impossible to recruit

An aging population and a seven day working week is going to make these hurdles even harder to jump. On top of this, more than a third of GPs hope to retire in the next five years. Extra funding might help, but that is not only unlikely, but if it is made available is likely to be too little, too late.

This is where my friend’s story comes in.

A portfolio practice

Current working practices dictate a top down approach. A national focus is used to determine the services that the GP practice provides.

My friend had what he called a ‘portfolio career’. He began by offering a single service, but quickly realised that by offering more services he could expand his client base and diversify from a single area of focus. Not only are his earnings spread among several clients, but across several business areas. What this gives him is protection against both the loss of a client and the loss of a particular business line (whether because of competition or economic forces).

If a GP practice could do likewise, it would protect itself against much of the problems it faces today.

How do you create a portfolio practice?

The provision of local care is becoming competitive. Different healthcare providers are offering specialist services, and patients have a greater ability to choose who will treat them. GP practices that have a limited service are putting themselves at risk of being superseded. However, there are strategies that the GP practice can immediately plan. For example:

- Extending services from the traditional GP role

- Develop effective partnerships

- Change how on-the-day demand is managed

By looking at local needs and current provision of services, a practice can strategise for the future and take advantage of gaps in the market. By doing this, the GP practice will be building a sustainable business model. The sticking point becomes the requirement for resources to enable a broader business strategy.

Ockham Healthcare believes that GP practices must show commitment to the needed changes to evolve into a sustainable model, but that the ability to do so must be supported by three key initiatives:

- An increase in funding, with some current requirements (such as the seven day working week) put on hold

- Funding transferred from CCGs to GPs to empower clinical leadership capacity that changes require

- Resources such as case studies, best practice, implementation tools, and change leadership expertise made available at local and national levels

What can the GP practice do to stop going the way of the Dodo?

GPs must commit to change and pushing for change on a local basis. With better and more effective partnerships and a broader range of services, a practice will help to protect itself from becoming extinct (certainly in the form that patients know it today). Of course, funding and resources must also be committed, at national and local level, to make this happen. Perhaps most crucial is for the system to place trust in its GPs, allowing them to act autonomously for the benefit of the communities that they serve.

Perhaps, in efforts to move to a portfolio practice model a practice should consider expanding the amount of private work it undertakes. Certainly, this would diversify the practice’s client base and reduce reliance on the NHS. And, by doing so, this would increase the leverage that the practice has when dealing with its chief paymaster, the NHS.

Does your practice feel threatened by its concentration of risk in a single customer (the NHS)? How will your practice push this conversation at the local and then national level? Let us know your views, ideas, and the efforts you’re making to evolve into a sustainable healthcare provider.

See also:

GP Trainee Numbers an Emerging Crisis in Primary Care

The Future of Primary Care

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