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

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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

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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: 67.13 million (2020), 71.04 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

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Health of the UK Ageing population ( Life expectancy 2010-12: Men 78.9 years, Women 82.7 years ) The big 5 killers Socioeconomic and geographic variation Rising chronic disease burden -Diabetes -Obesity -Dementia

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National Health Service Worlds 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

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

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

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GP within the NHS ~8000 practices ~36000 General Practitioners 6.5 GPs 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

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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.

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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)

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Patient Consultations (1996 - 2009) 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%

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Accountability and Monitoring To Authorities: GMC, RCGP, Care Quality Commission NICE (https://www.nice.org.uk/guidance)https://www.nice.org.uk/guidance To Colleagues: Portfolio Audit Appraisal/RevaIidation To Patients: GP Patient survey Care Comissioner

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GP Training 3 years: 18-24 months hospital 12-18 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

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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 3.95.4 (1995 vs. 2008)) Increasing waiting times Increasing patient complexity Aging population Higher patient expectations

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Thank you for your attention Aaron.Poppleton@doctors.org.uk

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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.37-43. 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: http://www.hscic.gov.uk/catalogue/PUB01077/tren-cons-rate-gene-prac-95-09-95- 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: http://www.mentalhealth.org.uk/content/assets/PDF/publications/starting- 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 2010. The Lancet, 381(9871), pp.997-1020. The King's Fund, (2014). Long-term conditions and multi-morbidity. [online] Available at: http://www.kingsfund.org.uk/time-to-think-differently/trends/disease-and-disability/long-term- conditions-multi-morbidity#ltc [Accessed 9 Dec. 2014]. (Aaron.Poppleton@doctors.org.uk)