GPs and QIPP: is there a doctor on board?

Now there is the added complication of asking if there is a doctor on board who could take over the controls. Preferably, one who doesn’t need much in-flight training. As a passenger, I’m not sure I can bear to watch.

Entrepreneurial GPs have huge potential to increase standards, yet they can be seen as unwelcome competition

Before handing over the controls, we must agree on our destination. QIPP has already posed tests for primary care and yet most of the answers have come from hospitals, despite GPs’ significance to the value chain.

Take data quality. While hospitals have sophisticated dashboards, there are crucial gaps for primary care. For example, the quality and outcomes framework gives points for an asthma review, without specifying outcomes. So reviews vary from a full MOT to little more than a polite greeting. Unsurprisingly, most practices score 100 per cent, even in high emergency admission areas.

We must be clearer about how diagnosis, risk management and referral are working. Better data won’t be available overnight, but we can analyse hospital data by point of referral and patient origin on practice lists. That would clarify care journeys, not just episodes of care.

Acute care has reconfigured to meet clinical evidence and patient need, but general practice lags behind. Swathes of general practice remain good for some but inaccessible for others, despite the good works of some entrepreneurial GPs.

One reason for high unplanned emergency admissions for conditions such as asthma is the dearth of out of hours support. Patients need rapid access to someone they can trust, whether by telephone, ambulance or urgent care team based. While the private sector moved to longer hours over the past decade, GPs retrenched into core business hours.

Hospitals have arguably been strengthened by competition, but primary care appears more inert. Pharmacy, for example, could play a bigger role for patients with long term conditions, especially where GPs have agreed a care plan, but developments have been piecemeal and limited.

Charities would like to play a bigger role in re-engaging patients, but progress has been restricted to a handful of conditions. Entrepreneurial GPs have huge potential to increase standards, yet even they can be seen as unwelcome competitors by their peers.

Hospitals have embraced telemedicine and digital technology - so can primary care. Common conditions such as asthma are already managed by template in general practice.

Patients often know a great deal about their condition. Allowing some to manage their health online, through their iPhone or in partnership with their pharmacy, could boost self sufficiency and restrain demand.

NHS Direct already allows online management. Pharmacy could also fill this role by tapping into repeat prescription patterns and acting on problems.

Primary care is becoming better at public engagement. I hope GPs maintain the focus developed by good PCTs. NHS chief executive Sir David Nicholson was right to warn at the NHS Confederation conference last month against a “consumerist” model of care, narrowly focusing on the needs of those walking through the clinic door.

Some of the heaviest lifting required of QIPP must be in disadvantaged areas, where renewed efforts must find and engage patients. For example, Hammersmith and Fulham primary care trust, investigating high hospital admissions among Pakistani men, began visiting taxi ranks at 2am, when drivers were ending their shifts and were receptive to advice. This targeted approach is helping bring down hospital admissions and reduce health inequalities.

The new arrangements for commissioning must be stronger on accountability. General practice must offer the same transparency that is becoming available from many hospitals. Tower Hamlets GPs are planning to disclose information on prescribing, access, satisfaction and practice income, but the existing benchmark is a long way behind this, and scrutiny appears quite limited.

Levels of exemption reporting remain questionable, with some practices exempting 40 per cent of their asthma patients and still earning maximum QOF points. The same is true of other conditions. Higher standards will be required before £80bn can be safely entrusted to new hands.

QIPP is an exciting vision for primary care, but questions must be answered about what we wish to build. By 2012, we need a fleet ready to fly and a common destination, not just a few able test pilots.