General Practice in the United Kingdom Aaron Poppleton (GPST1 - Preston, Lancashire)

An introduction... -Medical school in Manchester -Foundation years in Preston -Internal Medicine in Germany -Currently GPST1 in Preston -Masters in Global Health - NCD -Engaged to Liz

The United Kingdom Population of UK: 64.1 million Area: 243,610km 2 UK population density 259/km 2 –England 406/km 2 vs. Croatia 75.8/km 2 Population: million (2020), million (2030) Aging population: >75y - 8.3% (2015), 12.2% (2035) Ethnically diverse (87.17% white i.e. 7:1) –Around 7 million residents born overseas

Health of the UK Ageing population ( Life expectancy : Men 78.9 years, Women 82.7 years ) The ‘big 5’ killers Socioeconomic and geographic variation Rising chronic disease burden -Diabetes -Obesity -Dementia

National Health Service World’s ‘5th largest employer’ Budget of £109 billion (€137,7 billion) Funded through taxation - not health insurance ~2300 hospitals ~8000 GP practices 147,087 doctors (2013) 371,777 nursing staff (2013) ~8000 medical students/year

How does the NHS compare? Positively! - the Commonwealth Fund survey 2010

How does the NHS compare? Negatively…. UK health performance: findings of the Lancet Global Burden of Disease Study 2010

GP within the NHS ●~8000 practices ●~36000 General Practitioners ●6.5 GP’s per 10,000 people (1,540 people/GP) ●90% of NHS consultations ●8% of NHS funding ●Cover predefined population areas ●97% of UK population registered

Within a GP practice GPs: Partners, Salaried GPs, Locum GPs Nurses: Practitioners, Practice nurses, Auxiliary nurses Administration: Receptionists, Secretaries, Manager Other visitors: Health visitors, Midwives, Physiotherapists, Counsellors.

Roles of a GP Gatekeeper to the NHS Patient contact vs. Administration Very broad range of patients seen: –Mental health and addiction problems –Chronic disease management inc. pain –Disease prevention –Minor Surgery – cyst/lipoma excision, biopsies, joint injections, cryotherapy, ingrowing toenails –Palliative and End of Life care GPs with special interests (GPwSIs)

Patient Consultations ( ) GP Consultation type Face to face: 87% → 82% Home visit: 9% → 3% Phone: 3% → 12% Clinician type GP: 75% →62% Nurse: 21% → 34% Other: 3% → 4%

Accountability and Monitoring To Authorities: GMC, RCGP, Care Quality Commission NICE ( To Colleagues: Portfolio Audit Appraisal/RevaIidation To Patients: GP Patient survey Care Comissioner

GP Training 3 years: months hospital months GP practice Curriculum from the RCGP (368 pages) 12 areas of ‘professional competence’ 3 formal examinations: –AKT: Advanced knowledge test –CSA: Clinical skills assessment –WPBA: Workplace based assessment Online ‘Trainee e-portfolio’ Final meeting with supervisor

Challenges facing General Practice in the UK Workforce Too few GPs Too few trainees Uneven geographic distribution Funding Too little GP funding Further funding cuts Hospitals reducing services / hastening turn around Workload GPs are too popular! (consultations per patient 3.9→5.4 (1995 vs. 2008)) Increasing waiting times Increasing ‘patient complexity’ –Aging population –Higher patient expectations

Thank you for your attention

References Barnett, K., Mercer, S., Norbury, M. et al. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.The Lancet, 380(9836), pp Hippisley-Cox, J. and Vinogradova, Y. (2009). Trends in Consultation Rates in General Practice 1995/1996 to 2008/2009: Analysis of the QResearch® database.. 1st ed. [ebook] HSCIC. Available at: 09-rep.pdf [Accessed 6 Dec. 2014]. Ingleby, D., McKee, M., Mladovsky, P. and Rechel, B. (2012). How the NHS measures up to other health systems. BMJ, 344(feb22 1), pp.e1079-e1079. Mentalhealth.org.uk, (2014). [online] Available at: today.pdf?view=Standard [Accessed 11 Dec. 2014]. Murray, C., Richards, M., Newton, J. et al. (2013). UK health performance: findings of the Global Burden of Disease Study The Lancet, 381(9871), pp The King's Fund, (2014). Long-term conditions and multi-morbidity. [online] Available at: conditions-multi-morbidity#ltc [Accessed 9 Dec. 2014].