Mind the gap! Conflict and cohesion in primary care delivery models

Abstract

Provision of planned care (non-urgent, long-term conditions) and unplanned care (urgent, unscheduled, out of hours) presents modern primary care professionals, commissioners and provider organisations with conflicts both in models of delivery and in the skill mixes and training required. For 20 years we have attempted to resolve this conflict by tinkering with our current systems. Now that value for money within a shrinking financial envelope is paramount, it may help to look back at what has evolved, and then look forward to what excellent primary care could look like. Planned and unplanned care require different delivery models. Constant patient complaints over long waits to get an appointment, versus the need to provide continuity of care, are tearing primary care apart, and will continue to do so until we accept that two services need to run in an integrated way, with clear ways to manage the interface between the two. Some observers predict that the role of the general practitioner (GP) will split, and the 'Unplanned Care GP' could become a different species, with a different training curriculum, different employer, different work pattern and different expectations and outcomes. © 2014 Royal College of General Practitioners.