Designing a Utopian Training Programme?

GPFUQ #205 What’s the vision for the future of general practice?

Background – The Work Role crisis?

We know we have a UK NHS workforce and workload crisis but we also have a work role crisis. What is the role of the GP in the future and what do we need to change in training do to provide for the next generation of GPs? What’s the vision for the future and how are we going to get there?

The Bristol Trainers Day theme on 7^th March 2018 was ‘Futuristic Training’. This is a summary of the ‘Designing a Utopian Training Programme’  led by Shabi Nabi and Terry Kemple. There were about 70 trainers present.

How do we facilitate Continuous Quality Improvement?

The 5 questions to ask and answer before you start any changes

•What are we trying to achieve?

•What is already known about this change?

•What will success look like – what are our success criteria?

•What can we actually do with the limited resources that are available?

•How and when will we review this improvement plan?

What are we trying to achieve in health care?

The Triple Aim (2008) (US Institute for Healthcare Improvement)

1. enhance patient experience

2. improve population health   

3. and reduce costs  

Plus, one extra aim to make the Quadruple Aim adds (2014)

4. improve the work life of health care providers, including clinicians and staff 

What are we trying to achieve in primary health care?

Barbara Starfield showed:

Improved population health outcomes are associated with larger, stronger and more integrated primary care system

Her 4Cs of Primary care are:

•First Contact access,

•Continuity,

•Comprehensiveness, and

•Care coordination

Arguably all 4 have been undermined in current general practice

What’s the Vision for Primary Care and General Practice and how does it fit with everything else we need to plan and do?

  

Where are we going? What do we aspire to achieve? What are our hopes and ambitions for General Practice and GP training?

This is a summary of the vision for General Practice in the future. We will have:

·      Super practices (unless in a rural or remote location) that are the first contact for primary and holistic NHS care with

·      A sufficiency of GPs who are experts in undifferentiated symptoms and multimorbidity who are resourced to lead a happy multidisciplinary team that share the vision for health care via

·      Patient friendly efficient and effective Human and/or Artificial Intelligence triage processes  that leads into  either

·      Community based Hubs for urgent care and more local routine patient care with

·      All appointments sensitive to the needs of the patient both in length and with rapid access to right person at right time in the right place providing

·      Assured continuity of, comprehensiveness of and coordinated personal care when it’s important for a person’s best care and

·      Helping most patients to be excellent at self-care who whenever possible are responsible for their own notes and follow up providing

·      Good relations and integration with secondary care and other services, with more of secondary care services based in the community in

·      Buildings that are fit for purpose with

·      IT that is also fit for purpose where there is a

·      Work life balance for clinicians that facilitates improved productivity in optimal length working days provided by

·      GPs and other health care staff who enjoy flexible working and portfolio careers where

·      The financial disincentives to working as a GP have been removed (e.g. the costs of medical indemnity, pension capping,

And our GP training schemes ensures that

Every foundation doctor

·      experiences a high-quality GP post followed by

·      more flexible and bespoke options for GP training (e.g. matched to learning needs or circumstances with switching from other specialities without repetition of experiences, better accommodation of less than full time training)

Every doctor on completion of GP training

·      can cope with multiple care providers

·      understands all the benefits and risks of different employment status (partner, salaried, sessional GP)

·      appreciates and values the rights and responsibilities of having a rewarding professional role, rather than a rigidly boundaried job.

·      understands value of primary care to prevent over medications and over treatment

·      Knows the essential skills to be business partners and leaders to continuously improve health care

·      Can make time for continuing improvement creative thinking

·      Has had exposure to good continuity – a strong usual doctor/MDT who really knows the patient

·      Has had specific training for any enhanced roles ( e.g.GPSI, leadership both clinical and non-clinical)

·      Has had training packages in IT and other project organisation

·      Know how to nurture adaptable open and honest resilient teams

·      Can cope with optimal loads of information, bureaucracy and regulation and avoid the perils of their excess.

·      Can find an appropriate mentoring scheme in and after their GP training for continuing support

·      Can readily adapt to any necessary improvements in any aspects of health care (e.g. evidence-based medicine, IT developments, the way the multidisciplinary team works)

·      Is comfortable with less face to face contact with patients and more leadership in multidisciplinary teams

·      Has good time management skills