Falling NHS continuity of care poses ‘existential threat’ to patient safety

Rapidly falling continuity of care levels pose an “existential threat” to patient safety, Britain’s top family doctor will warn today as research reveals only half of Britons regularly see the same GP.

Prof Martin Marshall, chair of the Royal College of GPs (RCGP), will say trusted relationships between family doctors and patients are the most “powerful intervention” for delivering effective, high-quality care as they boost patient satisfaction and health outcomes, and reduce use of hospital services.

But in a keynote speech to the college’s annual conference, Marshall will warn that continuity of care is becoming almost impossible to deliver on the NHS amid soaring demand and shrinking numbers of GPs, in what he will describe as the “most worrying crisis in decades”.

There are mounting concerns over the ability of the NHS to tackle record waiting lists, with 6.5m patients awaiting care in England alone. Earlier this month Sajid Javid, the health secretary, admitted the current model of GP care “is not working” but insisted there would be no more money for the health service.

Marshall’s intervention comes after GPs in England threatened on Tuesday to take industrial action over a contract that forces them to offer appointments at evenings and weekends.

Medics at the British Medical Association (BMA) annual conference in Brighton called on the union’s leaders to act on a 2021 indicative ballot and “organise opposition” to the contract, “including industrial action if necessary”. GPs would be unlikely to stop providing emergency and urgent care, but could refuse to carry out other routine work or cut their hours.

At the RCGP conference in London, Marshall will tell delegates that because of rising workloads and fewer staff, GPs no longer have the time to properly assess patients, with 65% warning safety is being compromised due to appointments being too short, according to a recent survey commissioned by the college.

Only 39% of respondents said they were able to deliver the continuity of care their patients need – down from 60% two years ago.

The findings are backed by a separate study published today. A Queen Mary University of London review of 1m NHS patients found half (52%) regularly see the same GP despite growing evidence of improved clinical outcomes. The research found the patients who benefit most from seeing the same GP are those with long-term health conditions and people who visit a practice frequently.

However, Marshall will tell delegates the current state of general practice in the UK is “not conducive” to “the building of relationships”, adding: “On average three problems are presented in a 9.8-minute consultation – the second shortest consultations in Europe after Germany.

“At a time when workload is going up and the size of the GP workforce is reducing, as it is in the UK, this may require a redesign of how we work, with a shift from GP-as-all-things-to-all-people to a more focused approach, where we add value as members of a wider professional team – and continuity of care is one of those areas.”

Marshall will suggest that continuity of care can still be delivered, but perhaps not in the way it has been previously. “Continuity of care is a defining feature of family practice but doctors shouldn’t have a monopoly on its delivery,” he will say, citing examples of where good patient relationships are held by more than one clinician, such as nurses or physiotherapists.

Meanwhile, Tony Blair today urges the health service in England to radically reform how it operates in order to remain viable, declaring that “the NHS is a service, not a religion”.

A new report from the ex-prime minister’s Institute for Global Change warns that the NHS as a whole is at risk of going the same way as dentistry, with patients unable to get care they need.

In his foreword Blair says that the service’s founding principles – that it be available to everyone, free at the point of use and funded by general taxation – must remain in place. “However, the NHS envisioned by Sir William Beveridge and Aneurin Bevan – a centrally controlled, ‘one size fits all’ service focused on how we treat sick people – no longer fits the requirements of today’s world.

“The way the NHS is established and organised should not be and cannot be a matter of belief, but of practicality. As presently constituted, the NHS cannot be the service we now need.”

Ministers and NHS bosses need to embrace technology and innovation such as AI on a much larger scale, concentrate more on preventing illness and allow the 42 new “integrated care systems” – groupings of NHS bodies which launch on Friday – freedom from central control to decide themselves how best to deliver healthcare in their area, the report says.

Ministers will on Wednesday outline plans for a huge increase in the number of patients who self-monitor their own conditions and are treated at home in “virtual wards” in a bid to take the pressure off overstretched hospitals.

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