We know GP provision in the UK is facing some real challenges. Numbers of full-time, qualified NHS GPs are declining; recruitment has stagnated and those in practice are treating more, older, sicker patients, placing yet more pressure on the national health service.1,2
The private sector in turn experiences an increase in demand, as private hospitals and specialists have traditionally accommodated patients directed into their care from NHS GP referrals.3
We’re all chasing a diminishing resource and healthcare funders such as AXA Health have responded by offering a remote primary care service - in our case, AXA Doctor at Hand, delivered by Doctor Care Anywhere.4
For patients, the option of having private GP services provides a number of benefits, including being able to choose appointments at a time that suits them, and being able to speak to a GP online, from anywhere. The digital nature of this relatively new healthcare offer brings with it self-service efficiency and electronic patient records, while funders and providers get oversight and data to help improve the patient journey.
Finding a GP slot
But let’s step back for a moment. If you designed a healthcare system from scratch, where would you put the GPs? Would you recreate their role as gatekeepers to care?
The reorganisation of the NHS, passed into legislation last year, places its trust in ‘integrated care systems’ – many health providers working together.5 The change recognises how other caregivers in the primary sector (health visitors, community and district nurses, dentists, pharmacists, opticians and social care workers) can work better with GP practices for the benefit of patients.6,7 GPs themselves have asked, when you signpost to enough alternative services, what role remains for the family doctor?8
A 2022 report commissioned by NHS England and NHS Improvement advocated improving primary care by:
- streamlining the care and advice patients receive,
- promoting multidisciplinary teams to provide more proactive, personalised care, and
- helping people to stay well for longer.9
Private healthcare funders want no less for our customers. Many of the healthcare initiatives we’ve seen from insurers are designed to answer these challenges.
Looking beyond the GP
Beyond addressing the GP shortage with remote consultation, we can expect the next step to be a mixed, private clinical workforce which can better support patients. GPs are a highly-skilled, expensive and scarce resource and it’s sensible to use the skills of allied health professionals in the private sector who may be better placed to see patients with certain conditions, where cover is provided.
Because the mixed clinical workforce complements the GP role – but moves assessment and some gatekeeping away from the traditional model – insurers then need alternative ways to triage patients.
AXA Health’s direct access pathways19 aim to place assessment and triage at the outset of the healthcare journey, where patients can choose to bypass the GP and harness healthcare tech to ask more appropriate clinicians to direct the patient and deliver care.
Suspected skin cancer patients, for example, first see a dermatological nurse for imaging before a consultant reviews their case remotely. Where patients with muscle, bone and joint issues choose a digital route, they can be triaged online, assessed via online consultation and elect to pursue their healthcare journey remotely, doing physio via an app.
These pathways are delivering what our research tells us customers are looking for: speedy and efficient access to diagnosis and treatment.10 Thinking creatively about the GP role has helped AXA Health's direct access pathways have been able to place members with clinicians offering more appropriate and better value care for their health needs – physios or advanced level physios, for example, rather than orthopaedic surgeons.11
Health, not just healthcare
We can’t think one-dimensionally about primary care. We should also ask how patients themselves – our customers – can be part of the solution. Recent reports and initiatives from UK health bodies, looking to relieve pressure on the country’s healthcare system, have focused on how local communities can prevent ill health and how individual patients can be part of that.7,8,14
In a world of fierce medical inflation15, it’s in the interests of insurers to ask what might motivate our own customers to get and stay healthy. We can expect to see more behaviour change incentivisation via apps, fitness wearables, gym offers and lifestyle rewards from all players in the market.
But it’s hard to get healthy on your own. AXA Health also sees the importance of creating a health and wellbeing structure that will support an individual’s journey to health (we can see parallels here with the collaborative approach taking place in the NHS). This means bringing together the individual, their employer and the third parties who can deliver health advice, fitness solutions, wellbeing and mental health support, plus healthcare. This widens the meaning of primary care to encompass how our customers live and work and how they access health support when needed.
Workplace Health
Last year, we put a value on this sort of structure in our Value of PMI report, which measured the contribution of private insurance in getting people back to work, improving productivity, and improving quality of life.16 CIPD's Wellbeing at Work supports the premise that businesses who invest in the health and wellbeing of their staff are more likely to experience a decrease in sick days, increased retention and productivity gains.17 When we recognise that the national workforce is harmed by poor healthcare access718, we‘ll also see that the role of the insurer in changing the face of primary care will be crucial.
About Dr Pallavi Bradshaw
As Deputy Chief Medical Officer at AXA Health, Pallavi provides clinical and medicolegal advice; liaison with regulators and hospital governance teams; fitness to practice concerns; fraud and audit oversight.
Find out more and follow Pallavi on LinkedIn.
Background
Having read medicine at the University of Cambridge and undertaken higher surgical training in Ophthalmology, Pallavi has pursued further studies in law and business and worked in various strategic lead roles for the Medical Protection Society. She currently sits on the CORESS Advisory Board and has co-authored a chapter in the OUP Handbook of Patient Safety. She has media training, an extensive press portfolio and presents at national and international conferences as a key opinion leader in patient safety and medical ethics and law.
Deputy Chief Medical Officer, AXA Health | Exec MBA | Strategic healthcare leader
Footnotes
- Pressures in general practice data analysis, 30 March 2023 (bma.org.uk)
- NHS England, Primary care networks
- Research from AXA Health Provider Strategy Management Information (MI) analysis 2023
- AXA Doctor at Hand, provided by Doctor Care Anywhere
- Health and Care Act 2022 - NHS Providers
- NHS England, The journey to integrated care systems in every area
- Primary care networks explained, The King's Fund (kingsfund.org.uk)
- Do we really need GPs at all? Pulse Today
- Next steps for integrating primary care: Fuller Stocktake report, MS Word document - FINAL 003 250522 (england.nhs.uk)
- Why we buy: Quadrangle research for AXA Health (January 2022)
- AXA Health Provider Management Monthly Dashboard (January 2023)
- Royal College of General Practitioners (RCGP) - Fit for the future: A new plan for general practice (PDF)
- Prevention is better than cure (publishing.service.gov.uk)
- A vision for population health, The King's Fund (kingsfund.org.uk)
- UK medical insurance inflation nears 9% and global increases are 'unsustainable', Health & Protection (healthcareandprotection.com)
- The Value of Private Health Insurance, Frontier Economics, November 2022 (AXA Health)
- Wellbeing at work, CIPD (November 2022)
- Big rise in long-term sick hitting UK workforce, BBC News, (20 February 2023
- AXA Health's direct access pathways are available to members 18 years old and above.