Published: 03/10/2002 Volume II2, No.5825 Page 16
Specialist GP services are proving to be a winner in getting patient waits down.But they demand a new type of partnership with the acute sector.
Alastair McLellan reports from HSJ 's Breakfast with Champions in Leeds
'We are roped together on a cliff edge - if one goes, we all go.'
Not a comforting image from Dr Barbara Hakin, project lead of the national primary and care trust development programme.
But certainly one which will be an important motivator in creating the much-vaunted 'seamless service'.
Dr Hakin, who is also chief executive of Bradford South and West primary care trust, was speaking at HSJ's third Breakfast with Champions, a series of events exploring the issues raised by health service reform.
Around 100 health service staff arrived in Leeds last Friday for the breakfast, which was partnered by the Modernisation Agency and supported by PricewaterhouseCoopers. Dr Hakin was joined by the national clinical director for primary care Dr David Colin-Thomé, and chief executive of Leeds Teaching Hospitals trust Neil McKay.
The message from all three was clear - that demand and public expectation meant that patient-centred services, unhampered by traditional health service boundaries, were the only future for the NHS.
Dr Hakin's own area - Bradford South and West - is becoming renowned for its training of specialist GPs, which has resulted in the development of an intermediate tier of care. She stressed that they were 'not substitutes for consultants', but their greater knowledge ensured that consultants only saw those patients whose condition demanded it.
GPs now carry out much minor surgery, almost all elective endoscopy, gastroscopy and cystoscopy, a wide range of chronic disease management and extensive triage work. She said nurses, too, had benefited from specialist training, along with optometrists and physiotherapists - who had proved much better at orthopaedic triaging than GPs.
Dr Colin-Thomé later revealed that he had set up a national group dedicated to developing the role of nurses and allied health professionals with special interests.
The results have been impressive. The introduction of specialist GPs in Bradford had resulted in patient waits falling across the board: for endoscopy they were down from 'six to seven months' to 'two to three weeks', and in neurology from 49 weeks to five.
The good news did not end there, explained Dr Hakin. Such was the attraction of training as a specialist, the PCT had seen a 20 per cent increase in the total number of GPs over the last 18 months.
She underlined that the development of specialist GP services required a partnership with secondary care.
She said the 'best seller' of specialist GP services to other secondary care clinicians, was a urologist, a consultant who now claims that it has 'transformed his working life'.
This message was eagerly picked up by Mr McKay - who asked primary care colleagues to 'involve us'.
'You will find many champions for your plans - as well as lots of helpful ideas.'
The former NHS deputy chief executive proposed a four-stage process for delivering seamless services. First, a shared vision needed to be created. Next came the development of an agreed strategy - only then could you avoid the 'scatter gunning' which he feared was being encouraged by the pace of change within the NHS.
As a tertiary care centre, a third of his trust's income was from outside Leeds, he said. Getting a consistent message from PCTs on what constituted a seamless service was proving difficult. There was clearly a 'mechanism missing' that would avoid this problem, Mr McKay added.
In contrast, acute and PCTs within Leeds had agreed three main priorities: chronic obstructive pulmonary disease, stroke and elderly care. Integrated care pathways were being developed in all three areas, which involved the development of predetermined treatment plans that patients could expect to receive.
Third on Mr McKay's check list was employing the art of the possible. Nothing, he warned, would happen unless clinicians could be shown reliable evidence that a new way of working would bring benefits. Agreeing the benefits and outcomes the initiative was driving at was the final component of his blueprint.
Dr Colin-Thomé, who still practices as a GP in Runcorn, suggested the use of the evidencebased national service frameworks as an organisational development vehicle for seamless services.
He sketched a vision in which practices extended their traditional role. Personal medical services, he said, should be a major contributor to this. But he added:
'Most regional offices I know have dissuaded people from going down this model - maybe It is too messy [for them].'
However, in Dr Colin-Thomé's eyes PMS offered the possibility of re-engaging GPs who had been 'turned off ' by constant re-organisation. One way to rekindle GPs' enthusiasm for reform might be to use PMS-plus contracts to introduce 'aspects of hospital care' into primary care. It is an idea with friends in high places, he said: the prime minister, Tony Blair, is keen to retain PMS as an alternative to general medical services.
Dr Hakin underlined the desire in primary care to achieve greater influence by saying that the range of possible activity within PCTs should perhaps lead to them being renamed 'holistic care trusts'.
But ever mindful of the mountainous challenges already facing PCTs she reminded the audience of the help that her organisation - the national primary and care trust development programme - could provide to help develop these fledgling organisations.
Dr Colin-Thomé saw the development of PCTs as a chance to break down the divides between primary and secondary care - with leaders for change emerging from both fields.
Both he and Dr Hakin concluded by stressing that patientcentred services will only be developed if the service is measured by how it performs as a network - rather than just as individual organisations.
If the NHS is to succeed in serving patients well, it is not only the services which must be seamless.