General practice is in crisis – or at least that’s the title Professor Martin Roland, RAND Professor of Health Services Research at the Primary Care Unit, used in his recent BMJ editorial and few would disagree – problems recruiting, rising workload, increasing stress and doctors retiring early. Today NHS England comes out with its solution in the General Practice Forward View.
There’s quite a lot of agreement about what’s needed. The Primary Care Workforce Commission which Professor Roland chaired last year set out 38 recommendations in The Future of Primary Care to which Health Education England have already responded with a range of initiatives. Today the House of Commons Health Committee also publishes its Report on Primary Care. The Commons report endorses the Commission’s proposals and makes clear that more money is needed for primary care.
The new NHS England commitments are introduced by Simon Stevens, Chief Executive, who writes “if anyone ten years ago had said: ‘Here’s what the NHS should now do – cut the share of funding for primary care and grow the number of hospital specialists three times faster than GPs’, they’d have been laughed out of court”. And Arvind Madan, NHS England’s new Director of Primary Care and a GP himself writes “Clinicians increasingly feel unable to provide the care they want to give, and understandable resentment of working under this pressure is growing”.
So how does NHS England’s response stack up? Pretty well according to Maureen Baker of the RCGP who calls it ‘the most significant announcement for general practice since the 1960s’. Sounds like the package exceeds even the College’s expectations. First on funding, where general practice funding has declined from 11% to 8.4% of the NHS budget in England over the last 10 years, there’s a commitment to increase this back up to over 10% by 2020 – an extra £2.4bn a year. Impressive in tough economic times. So my view is that Maureen Baker is right. This report will be seen as a turning point – as important as the 1965 GP charter. A good day for primary care
– Professor Martin Roland, RAND Professor of Health Services Research
The new proposals from NHS England are detailed, extend over the short, medium and long term, and mostly have timetables and money attached. They include:
- Confirmation of commitment to a range of measures already announced – 5000 extra GPs by 2020, a national campaign to promote general practice as a career, £20,000 bursaries for GP trainees in hard-to recruit areas, making return to work easier, an international recruitment campaign, and a new announcement of £16m for specialist mental health services for GPs suffering burnout and stress (an acknowledgement if there ever was one that something needed to be done).
- An expanded multidisciplinary workforce – 3000 extra mental health therapists working in primary care by 2020, £112m for 1500 pharmacists working in general practices by 2020, 1000 new physician associates in general practice by 2020, £15m for practice nurse development programmes, £6m for practice manager development, £45m for training receptionists to take on more clerical work that GPs currently do, and piloting a new ‘medical assistant’ role to reduce GPs’ admin burden.
- A new NHS Standard Contract for hospitals to reduce the amount of work increasingly being dumped on general practice – stopping automatic discharge of patients who DNA, removing the requirement to refer back to the GP if another specialist’s opinion is needed, clear standards for communicating results to patients and GPs, and better communication all round.
- CQC inspections reduced to five yearly for 87% of practices with a commitment to review the assessment process itself (though in my view the latter could be strengthened)
- £900m for capital investment in general practice premises
- A major programme of IT development including £45m to develop online consultation systems, and a programme to develop a library of approved apps for patients and clinicians.
- Reform of NHS 111, and clarification that ‘seven day working’ doesn’t mean that every practice has to be open seven days