This 2011 report considered the contribution of medical generalism and the role of the generalist in the healthcare system. Amongst its many finding, this report repeats evidence that people with long-term conditions account for 50% of all GP appointments, 64% of all outpatient attendances, and 77% of all hospital bed days.
In 2009-10, an estimated £70bn was spent on the health and social care of people with long-term conditions. Professor Alistair Burns, National Director for Older People and Dementia at the Department of Health submitted evidence that 25% of NHS hospital beds are occupied by people with dementia and up to 40% have ambulatory conditions which may not need to have been admitted to hospital.
One factor which acts to undermine the self-worth of GP generalists is the trend towards performance assessment and reward systems which emphasise achievement of treatment and prevention targets. These approaches may have their merits, but can impose a straitjacket on GPs and focus on “process” at the expense of meaningful patient outcomes for the whole person. The Commission on Generalism / RCGP assert that performance measures and reward systems – notably the Quality and Outcomes Framework (QOF) – should take into account a broader range of outcomes. David Oliver said:
‘There is a real issue in my view with the business model of general practice, with quasi-autonomous contractors being driven excessively to focus on QOF, meaning that commonplace conditions such as dementia, osteoporosis or incontinence are less well-managed”.
Finlay, I. [Baroness Finlay of Llandaff] and The Commission on Generalism (2011). Guiding patients through complexity: modern medical generalism. Report of an Independent Commission for the Royal College of General Practitioners and The Health Foundation. London: Royal College of General Practitioners (RCGP), 2011. 32p.