Rhetoric and reality in person-centred care: introducing the House of Care framework

Many GPs have read NHS England transformation plans and met the ‘primary care home’ model. The recent article on the House of Care¹ promotes the model from a different perspective and suggests benefits from enhancing patient-centred care (PCC), professional exchange, and reducing care inequity. The irony of the imperative to revolutionise and address perceived deficiencies in delivering PCC in the name of patients’ opportunity to take control is however awe-inspiring. By the authors’ admission the PCC construct is immature and it ‘probably leads to only small improvements in some indicators of physical health’. By contrast traditional GP care has high patient satisfaction and given the opportunity patients choose technical quality of care and relationship continuity over PCC.²

In an austere environment in which scant primary care resources are dwindling, attracting staff is becoming impossible, the demand for performativity (being seen to do rather than really do) escalating, and morale at a nadir, GPs are pragmatism experts. Inevitably, resilience in primary care is essential and at its core lies a moral compass.³ My compass asserts that, although as a pragmatist I accept healthcare delivery must change, the process by which it is being done is paternalistic, inherently dishonest, and disempowers patients.

This economist-driven enterprise may coincidently improve professional exchange, care coordination, and variability in areas of high population density, but will have a devastating impact on our profession through placing structure and function ahead of people and values. Our local plan fails to define the key attributes of GPs, 50 years to define and 50 months to defile. On the ground, the gap between the expressed cooperative ideology and the rapid deconstruction of valued, effective resources is demoralising. All this and little evidence that patients have been consulted, empowered to contribute, or given alternatives to consider.