Simplistic NHS reforms are inadvertently damaging patient care

Simplistic and unpiloted NHS reforms are inadvertently damaging patient care in general practice, according to a group of academics writing in this week's BMJ. Professor Howie, from the University of Edinburgh, writing with colleagues, criticises recent reforms in general practice and says if they "continue unchallenged [it] will result in the dismemberment of a primary care system that has been the envy of other countries."

They argue that the holistic care patients have always received from their GP, and which has worked in the individual patient's favour, is in danger of being harmed by recent changes.

The most serious of which is the way "tinkering" reforms will change the successful model of general practice which provides continuity of care by a known GP, to one in which patients are seen by a variety of healthcare workers in different sites who treat episodes of illness rather than the whole person. They argue that "the best of the past is in danger of being lost without sufficient proven benefit in return."

They point out that the government's insistence of using general practice to implement a public health agenda has had the knock-on effect of patients not being treated as individuals, because priority in consultations may be given to the public health agenda over the reasons the individual went to the GP in the first place.

In addition, they criticise "perverse incentives" such as the Quality and Outcomes Framework, which financially rewards GPs for hitting targets, and claim that it provides poor value for patients. "Ticking boxes," they say, may distract doctors from dealing with important topics during a consultation.

Both these factors have created extra work for family doctors, which in turn has led to it becoming increasingly difficult for patients to get timely access to care from their first choice of GP.

These reforms, they conclude, if allowed to continue will mean that "patients will lose holistic care, doctors will lose job satisfaction and the NHS will lose effectiveness and inefficiency."

Source: BMJ-British Medical Journal