We need a more collaborative and proactive approach between community and hospital

11 February 2022

Call me protectionist but I’ve always regarded the physical separation of GPs and specialists in the UK as good thing for everyone. We do different jobs, we thrive in different environments. The ‘Division in British Medicine’ which historian Frank Honigsbaum described in his 1979 book is the result of a 19th century battle in which specialists won the hospital beds and general practitioners won the patients. A political compromise perhaps, but an advantageous one for everyone.

But the separation is becoming wider, a dangerous chasm is opening up. Patients are falling into the gap, GPs and hospital specialists are finding it increasingly difficult to talk to each other, tempers are fraying.

The working model between generalists and specialists needs a rethink. 

First, we need to replace the ‘I’ve-done-all-I-can-please-take-over’ model with a more collaborative and proactive approach between community and hospital clinicians which predicts and plans for the needs of complex patients. Second, we need to change the discharge process - patients leaving hospital are sicker and have more complex needs than in the past, they might be better off at home but only if they have greatly improved access to their specialist teams when things go wrong. And third, we need to reinvent intermediate care structures. The community hospital network, largely sold off for a quick buck, served an important purpose. Perhaps virtual wards can fulfil that role, let’s see what the evidence says.

We need to reinvent intermediate care and for the good of patients we need to do it quickly.


Latest updates from your College

Elective recovery plan and White Paper on integration

You'll have probably seen that NHS England and the Department of Health and Social Care have published their elective recovery plan, ultimately aiming to clear the backlog cause by the pandemic. It’s an ambitious plan, and there are some ideas we can get behind, but it’s very focused on hospitals, and the College has been vocal that the plan must not overwhelm a GP service already stretched to its limits.  

You can read my full response here, which reinforces the point that NHS pressures are not just confined to hospitals. 

We know that whilst patients are waiting for treatment or operations in secondary care, their health is under the care of GPs and our teams in the community. It’s crucial that any plans to alleviate the backlog in hospitals do not inadvertently push a bigger burden onto general practice. It is also essential that, in line with the assurances given by the Secretary of State, the proposals do not worsen health inequalities.

We also saw this week the publication of the Government’s White Paper on integration of health and social care – a joint endeavour between DHSC and the Department for Levelling Up. The aspiration of the paper, to ensure patients receive better, more joined-up care, is a good one. But as with the elective recovery plan, the elephant in the room that is not being addressed, is the staffing crisis, not just in general practice but across the NHS.

We're currently digesting the paper to ascertain the implications for general practice and the patient care we deliver. Rest assured, we'll raise any concerns we have at the highest levels.

Speaking up for the partnership model

A couple of weeks ago, we hit back at some startling headlines in The Times about plans to ‘nationalise’ general practice. I’ve now made the case on the influential politics.co.uk website, and I hope politicians of all persuasions will take heed.

The GP partnership model is the backbone of NHS general practice – and there is still a strong appetite within the profession for GPs to become partners. General practice needs radical thinking, but this should be focused on support for GP teams and addressing the staffing crisis, not meddling with a business model that works well for the NHS and patients, and that is cost effective for the taxpayer.

RCGPAC 2022, in conjunction with WONCA Europe

Please book now to secure your discounted earlybird ticket for our 2022 Annual Conference, in conjunction with WONCA Europe. The deadline for discounts, of up to £75, is 28 February so don't miss out. 

The Conference will be a great opportunity to connect and share ideas and experiences with a global network of practitioners. 

You can register now.


Post written by

Professor Martin Marshall, Chair of RCGP Council

Professor Martin Marshall is Chair of the Royal College of General Practitioners and a GP in Newham, East London. He is also Professor of Healthcare Improvement at UCL in the Department of Primary Care and Population Health. Previously he was Programme Director for Population Health and Primary Care at UCLPartners (2014-2019), Director of Research & Development at the Health Foundation (2007-2012), Deputy Chief Medical Officer for England and Director General in the Department of Health (2006-2007), Professor of General Practice at the University of Manchester (2000-2006) and a Harkness Fellow in Healthcare Policy. 

He is a Fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012. He has advised governments in Singapore, Egypt, Canada and New Zealand, has over 230 publications in the field of quality improvement and health service redesign and his primary academic interest is in maximising the impact of research on practice. In 2005 he was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. 

A co-founder and driving force of the Rethinking Medicine movement, Martin has a passionate commitment to the values of the NHS, patient care and ensuring the GP voice is central in a time of great change. When he’s not working, he likes being outside, preferably on a mountain or a coastal path with his wife Sue and their puppy. 

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