BMJ Roundtable: Future of primary care

The future of primary care could see GPs taking back out of hours care, according to Clare Gerada, chair of the Royal College of General Practitioners in a roundtable discussion hosted by the BMJ.

It will also see practices embracing technology and leading an integrated service, managing patients with both health and social care needs within the community.

But for all this to happen will require changes to the current workforce, better investment and training – as well as improved integration with community services, social care, and the hospital sector.

This is the vision of experts, brought together by the BMJ last month to discuss some of the challenges facing general practice in England and Wales – and how they can be addressed in the future.

The discussion also involved Nav Chana, postgraduate dean of GP and community based education at the London Deanery, Helen Thomas, former GP partner, and current GP SHA lead for the south west, and Judith Smith, Director of policy at the Nuffield Trust. The discussion was moderated by BMJ primary care editor, Domhnall MacAuley.

All participants agree on the importance of providing high quality, coordinated care in the community. They also recognise the “independent and innovative nature” of general practice, but point to the “systematic fragmentation” of services and say primary care should “build on what works … by delivering first-contact care to patients across the physical, psychological and social domains.”

Clare Gerada says general practice “has delivered what it said on the tin” but “is at its tipping point” and needs to change.

She believes that, in 10 years time, GPs “will be leading integrated teams” in both a provider and some commissioning role. She thinks the patient of the future “will be able to engage with their GP practice remotely, from registration to treatment and discharge through electronic prescribing and electronic referrals.”

The patient of the future will have “an equal relationship” with their GP, she adds.

Stethoscope by Hospital

Stethoscope by Hospital

Judith Smith believes the general practice in the future will be “the gateway into a wider network of services” and that we need to move away from the idea “that it is always the GP that you see.” But Clare Gerada argues that “whatever our vision is, it has to be predicated on more GPs spending longer with their patients and communities, with longer training.”

On the out of hours question, Nav Chana says it’s “doable, but we have to look at the entire system design in order to support that.” Helen Thomas points to agrees, saying she would be happy to do out of hours if current shortcomings in accessing patient notes electronically were addressed.

On clinical commissioning, Judith Smith believes it may give GPs “real potential” to work more closely with secondary care colleagues to provide care for people with complex needs.

The need for GPs and hospital consultants to “speak the same language” was also seen as crucial to the future of primary care. Nav Chana talked about “population-based healthcare” where “clinicians actually work collaboratively together across that population interface.”

Dr Gerada concluded by saying: “I think that the healthcare of the future is positive as long as we invest in general practice.”

Image by Hospital (Own work) [CC-BY-SA-3.0 ( or GFDL (], via Wikimedia Commons

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