This is the first blog in a series about primary care, where we’ll look at the factors that have brought general practice to a state of crisis.
The current primary care model is at a breaking point. Young general practitioners (GPs) are seeking employment in lieu of owning practices. Patients are increasingly complex, which means GPs need extra resources to care for the same number of individuals. New government incentives promote preventative medicine. And to top it off, patient expectations are evolving, which puts pressure on GPs to respond to trends immediately while keeping patient experience top-of-mind, lest they lose clients.
GPs are beginning to transform how they provide care in response to these pressures, but they can’t do it alone. This presents an opportunity for hospitals, health systems, and payers to consider how they can partner with GPs in the transformation of primary care.
Changing demographics influence access
Doctors are increasingly young and female—in the United Kingdom alone, 40% of female doctors are under 35. This translates to a workforce push toward a better work-life balance and stable, salaried employment. In the UK, we have seen over a 400% increase in salaried GPs since 2003.
This trend will continue as more baby-boomer practitioners retire, but it’s already restricting patient access. In British Columbia, Canada, over 200,000 citizens are without a family GP, a number that is up 25,000 since 2012.
GPs unequipped to handle complex patient population
The GP role is more complex than ever. Greater numbers of patients struggle under the burden of multiple chronic illnesses—66% of Australians over 60 are now multi-morbid. Rising complexity means that a quick conversation is insufficient to address a patient’s needs, yet many GP appointment slots are 10 minutes or less.
Wait times to get to secondary care are only exacerbating the issue. According to the Fraser Institute, the median wait time in Canada for a consultation with a specialist is nearly 10 weeks. These patients are forced to lean on their GPs while waiting for additional care.
What’s more, GPs now have more administrative tasks filling up time that could be spent seeing patients. To highlight just one example of this, United States GPs spend an average of 48 minutes per day on their EMRs.
With all of these pressures, it’s no wonder that GP burnout has become a global issue.
Pressure from all sides
GPs are struggling under the weight of increased payer and patient expectations. Payers are shaping how and where care is delivered by implementing a variety of incentives and quality targets for GPs. The Australian Practice Incentive Programme incentivises GPs to provide certain levels and types of services in residential aged care facilities, for example.
In some economies, the patient has increased choice over what care they receive, which has led to innovative offerings that influence how they choose care: walk-in clinics in Canada; concierge medicine in the US; on-demand visibility into competing out-of-pocket care costs in Australia.
Patients want primary care when and where it works for them, whether that’s on a Friday evening or inside their local pharmacy. If they can’t find it with their current provider, they’ll go somewhere else.
Why hospitals need to care
GPs have begun transforming to meet these pressures, but it’s not happening fast enough. And a well-functioning primary care sector is the lynchpin of a successful acute sector. When care is managed comprehensively in the community, it prevents patients from flooding the ED unnecessarily.
As such, hospitals must engage with GPs to better understand the challenges they face, and then partner with them in the transformation of primary care.
Stay tuned for our next blog in this series, where we will break down what hospitals can do to partner with primary care to accelerate its transformation.