What does the future of primary care hold?

Domhnall MacAuley paints a bleak picture of the future of primary care in the UK. One in which our experience will be dominated by discontinuity of care, and doctors with no real sense of personal responsibility for their patients. How might we do better than this?

1. Redefine the ‘new professionalism’

Personal responsibility for patients has, historically, been a defining feature of general practice in the UK. Without it, as patients we find ourselves “recounting our medical history to endless different professionals who focus on segregated parts of our health and know nothing of our past” as Domhnall MacAuley suggests. In recent years we have seen the insidious erosion of personal responsibility for patients in primary care. Redefining the ‘new professionalism’ to better recognise the value of personal responsibility for patients might help to (re)promote personal, continuing care in general practice.

2. Think critically about how we define ‘quality’ in health care

When it comes to managing quality, there are some things that we find easier to measure – and therefore easier to attach financial incentives to – such as access. Other dimensions of quality are less easily quantified. For example, the co-ordination of care. Over time, this difference in ease of measurement may have an important influence on how we come to define ‘quality’ in health care. Perhaps the growing fragmentation evident in UK primary care stems, in part, from our collective failure to incentivise the things we find difficult to quantify. The net result? Our definition of what quality is, may become unnecessarily shaped by what can be easily measured.

3. Consider how performance management strategies may influence professional values

Pay for performance is not a panacea: unintended consequences can include detrimental effects on aspects of care that are not incentivised and, potentially, incremental changes in professional values and behavioural motivation. Specifically; the increasing use of P4P in general practice could mean that behaviours originally motivated by intrinsic reward, come to be motivated instead by extrinsic (financial) reward. Perhaps this is inconsequential to the quality of care? Possibly not, as the provision of personal, continuing, primary care may rest upon on professional values that are nurtured by intrinsic motivation.

Domhnall MacAuley is right: the traditional GP providing personal, primary, and continuing care is indeed becoming a rarer species. But the future does not need to be entirely bleak. What I find very useful about Dr MacAuley’s blog, is that it energises us to strive to create an alternative vision – one that contributes to a more positive future for primary care in the UK.

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