Patients should be able to see SAME GP every time, says safety watchdog after death of man with cancer

Patients should be able to see the same GP every time to reduce potentially fatal delays in diagnosing serious illnesses, the safety researcher said.

The Health Service Safety Investigation Body also wants computer systems to be updated so they alert doctors if someone comes back with the same problem.

It came after a man recovering from breast cancer repeatedly visited his GP for back pain and also visited the emergency room, where his family said he was accused of wasting his time.

He was eventually diagnosed with secondary breast cancer that had spread to his back and a tumor was pressing on his spinal cord.

The patient, Brian (67), saw at least two GPs out of hours, six GPs in the practice, a nurse and a physiotherapist in the GP practice and attended the emergency department over an eight month period.

He later died of his cancer.

One study found a number of problems, including that GPs’ workload affected patient care, that there was no national system for continuity of care, and that patient records were often presented chronologically, meaning there was a pattern of repeat visits for the same matter was missed if combined with appointments for other medical conditions.

The HSSIB defined continuity of care as a relationship with a particular physician, but also as the way in which information is managed in a practice so that each physician can care for the patient.

The HSSIB concluded: “HSSIB recommends that the Department of Health and Social Care ensure that the GP contract expressly includes and supports the need for GP practices to ensure continuity of care.”

“It is intended to improve patient safety by building doctor-patient relationships and providing information continuity.”

In its report, the HSSIB states that there is no specific obligation for general practitioners to ensure that the practice provides continuity of care for their patients.

General practitioner data for May 2023 shows that there are 27,200 fully qualified GPs in England. This is a decrease compared to the 27,627 last year. GP numbers peaked at 29,537 in March 2016

They could do this voluntarily, but there was no standard framework to achieve this, leading to inequalities across England.

“Some practices have implemented systems effectively, but many have not, and HSSIB research has shown the impact the lack of a formal system has on patient safety, GP wellbeing and practice operational efficiency,” the report said.

The researchers reported that all the GPs they spoke to were aware of the benefits of continuity of care, but some did not believe it could be achieved in their practice.

Barriers included the complex social conditions of the geographical area and the availability of staff.

The investigation also found that there is no need for GPs’ IT systems to take into account continuity of care or “feed” information to GPs so they can see that people are returning with the same problem. It has made recommendations to NHS England on this issue.

Neil Alexander, lead safety researcher, said: “What our team noticed during the investigation were the marked differences in patient experience and GP wellbeing between practices that adopt a continuity of care model and those that do not.”

“We could see that they all want to provide the best possible care, but the extreme pressure of the workload and the need to prioritize other essential requirements makes this very difficult.”

“While practices have seen benefits with systems, they have told us that they are often implemented without the right framework, guidance and explicit funding.

“It became clear to us that if GP practices want to consistently prioritize continuity of care, it must become part of the essential services they must provide.”

“Brian’s case was a clear example of what can happen when that continuity is broken – it was incredibly painful for him and his family.”

“He told our team: ‘When I’m gone, no one else has to go through what I did.

“The emotional impact was also evident in interviews with his practice, with one GP describing the current system as ‘brutal’.”

The HSSIB defined continuity of care as a relationship with a specific doctor (archive image)

Dr Victoria Tzortziou-Brown, vice-president of the Royal College of GPs, said that continuity of care is “highly valued by both GPs and patients…but providing continuity of care is becoming increasingly difficult as GPs and our teams must contend with the enormous pressure on staff and need to grow, both in scale and complexity.’

She said a recent survey by the RCGP found that 54 per cent of GPs were unable to provide consistent continuity of care in the way they wanted and met the needs of their patients.

She added: “It is not easy to make continuity of care a ‘requirement’ as it can mean different things to different practices and patients, and some patients may value and benefit from it more than others.”

“Ultimately, given the current pressures, it is hard to imagine how such a requirement would be feasible for many practices.”

A spokesman for NHS England said GPs were making record numbers of appointments and the health service was making it easier for patients to book consultations.

A spokesperson for the Department of Health and Social Care also said: “Continuity of care is important and all patients should be provided with a named GP.”

“Practices must try to accommodate all reasonable requests from patients to see a particular GP or other health professional and people have the legal right to choose which practice they register with.”

“We’re making it easier for patients to see their GP by cutting red tape so practice teams have more time for their patients, and we’ve committed £240 million in additional funding to improve technology in GP practices so patients can “network. ” may include it. .

“Compared to 2019, there are now an average of 29 more appointments in each GP practice per working day, more than 2,600 additional doctors and 34,000 additional employees.”