General Practice is a key player in shaping a system that addresses the wider determinants of health, says GP partner in Nottinghamshire as a 10-year NHS reboot is set to be unveiled
She might only be 34 but my patient Donna has dealt with a lifetime’s worth of struggles.
A survivor of child abuse, she used alcohol and drugs to cope with her trauma. Diabetes, obesity, anxiety and depression are among the problems Donna faces. The single mother has limited access to healthy food and multiple children with special education needs. Unstable housing and financial insecurity compounds her health too. Frequent hospital visits and lengthy specialist care waits have left her isolated and overwhelmed. Donna is fictional – but her problems are real, based on the experiences of patients helped at my surgery.
The 10-year NHS plan aims to tackle these societal and systemic challenges – putting patients like Donna at the heart of care and addressing the wider determinants of health.
But does it go far enough? As more information emerges, the devil will be in the detail. And outcomes will be measured by the effectiveness of its implementation.
Since I started as a GP in 2010, most practices have adopted multidisciplinary team working and have evolved into a hub of integrated, community-focused care. However, GP numbers have massively reduced – with a significant increase in complex workload at the same time.
Many GPs are stressed, burnt out and only able to provide a reactive fire-fighting model of what we nickname “sick-care” – when ideally we would helping keep healthy patients fit too. Significant numbers of GP premises are unfit for purpose – so increased funding is desperately required to house these proposed neighbourhood teams. For the planned blended service provision to be effective more funding must follow the patient.
Most GP practices now work closely with pharmacists, physios, mental health workers, social prescribers – who connect people to community support – and social workers, housing advisors, and local charities. This multi-agency approach helps patients navigate complex circumstances — from securing stable housing to making healthy food choices — which are imperative in managing conditions such as diabetes.
Prevention through education and awareness is key. Continuity of care – which means seeing the same doctor – reduces all causes of death. This can only be achieved by improving GP recruitment and retention. As well as training more GPs, we need to make the profession an attractive proposition again, to stop GPs from leaving and keep practices open. More GP funding is needed too.
Already we are seeing a shift to longer, personalised consultations to enable understanding of the uniqueness of people’s lives. The 10-year plan’s focus on integrated care and tackling health inequalities should improve patients’ experience. General Practice is a key player in shaping a system that addresses the wider determinants of health. And how we help patients like Donna to live her life will be the test of its success.
Dr Singh was awarded an MBE in 2020 for services to healthcare in Nottinghamshire. He is part of the Rebuild General Practice campaign, grassroots GPs who want to work with the government to improve general practice