The current “target culture” within the NHS is leading to patients getting the wrong treatment, a major new report has warned.
The many guidelines used in general practice that encourage GPs to recommend a particular intervention or medicine to patients with a specific condition is leading to some people being pushed into treatments that they do not want and denied other forms of support that they need, says the study.
“In some cases, high levels of compliance have become a requirement of the regulator. In these circumstances, the GP is under considerable pressure to persuade a patient to accept a certain medicine or innovation,” it adds.
The government needs to set up a “transformation fund” to drive a seismic shift in general practice, urge the authors of the independent report, which was commissioned by the Royal College of General Practitioners (RCGP) and based on an inquiry into patient-centred care in the 21st century launched last June.
They call for a revolution in the way general practice is delivered, moving away from the traditional “cottage industry” model of small, relatively isolated surgeries towards an area where clinicians work differently with patients, and practices increasingly work together at scale, for example in federations, with other parts of the NHS.
A new relationship between patients and clinicians is also needed, in order to meet the diverging expectations of patients today; many are keen to take advantage of rapid developments in IT to access clinicians and to take more responsibility for their own care, while a growing number need increased support due to the massive increase in people with multiple long-term conditions (LTCs), it says.
Written by former NHS Confederation chief executive Mike Farrar and a team of 10 advisers from across the healthcare sector, the study makes 46 recommendations, including calls for:
- a move away from “tick box” clinical guidelines and performance indicators to an approach that recognises the need for care to be tailored to patients with complex conditions and rewards clinicians for respecting patients’ preferences, “instead of penalising them both financially and reputationally;”
- promotion of greater public awareness of the costs of treatment and the appropriate use of healthcare services, through increased communication by politicians and NHS leaders and improved access to cost data;
- financial incentives and support to be offered to practices to implement and evaluate new technologies to improve patient access and care;
- the production of information and tools which enable clinicians to explain to patients the benefits and risks of treatments and how these vary depending on personal circumstance, for instance according to the number of LTCs a person has; and
- more research to be undertaken into effective treatments for people with multiple morbidity, supported by an increase in the proportion of resources devoted to this area by research funding bodies.
Commenting on the report, inquiry chair Mike Farrar said: “it is becoming increasingly clear that we need a seismic shift in the way care is delivered, as well as in the attitudes of clinicians, to ensure we can provide care to patients that is centred on the individual and as close to home as possible.”