New primary care approach needed – pharma must seize chance

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Back to the future

The current approach to primary care is toast – pharma, this is your chance.


Few things seem to be as unchanging as a GP surgery, and there is a fair chance you’re reading this thinking that yours has hardly changed since you registered. So, when I say that multiple tipping points suggest that primary care will radically alter, then you may not believe me.

I work with two GP federations in very different areas. Yesterday, at one board meeting, we discussed a nursing workforce review, which revealed the majority of our nurses are aged over 51 and 29% are over 56. Last week, in the other city, yet another practice ‘handed the keys back’ and announced its closure.

Ultimately, the future belongs to places like Encompass in Kent. This facility is a superb example of integrated out-of-hospital care made viable by scale; replicating leadership, a coherent strategy linked to a clear vision and data to build the plan.

The truth is that the traditional primary care model is already an anachronism, and only complacency, wishful thinking and nostalgia stand in disagreement. We have GPs consulting 80-100 patients a day and our nurse headcount is twice the whole-time equivalent. It’s the same with admin staff and not far different for GPs.

Overheads of all kinds follow inefficient cottage industry approaches, while many practices pursue Quality and Outcomes Framework (QOF) rewards or enhanced service income, without understanding the cost of delivery and, therefore, the margins.

Few practices are run as businesses, based upon accurate income and expenditure. Indeed, this is a potentially productive area for pharma that too few companies address. Primary care is disintegrating, so industry should seriously consider supporting practices in modern business execution.

Margins are actually incredibly narrow and I’m learning the costs to a practice of routine secondary care activity are significant in tipping them to loss. I don’t mean the admission cost to the CCG that is paid to the hospital, but the associated costs to the actual practice of referral, follow up and diagnostics. Unpicking this makes or breaks a practice, as does the necessary efficiency to avoid a loss from chasing QOF or flu vaccination targets.

Pharma value proposition models tend to ignore practice costs and budget impact models are much more detailed around CCG admission costs. Field staff generally over-estimate the value of things like QOF and cannot place finances into context, as practice finance barely features in training courses.

In the final analysis, industry could work closer with practices and federations to collect, interpret and act upon data. Managing new models of primary care we so badly need is something pharma can and should be compelled to do. 


Irritating QOF

The QOF is a 13-year-old, periodically updated system, still in use today. It’s a way of gauging and rewarding general practice performance against criteria in several disease areas, such as heart conditions, diabetes, mental health and cancer. QOF is part of the General Medical Services contract and is also designed to identify areas of improvement.

David Thorne is Chair, Washington Community Healthcare and Non-Executive Director, City and Vale GP Alliance.

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