6 February 2019

A renaissance for general practice?

Martin Marshall, Programme Director for Primary Care and Population Health, UCLPartners and GP, Newham, East London

General practice has been on the ropes for more than a decade. What has long been regarded as the jewel in the crown of the NHS has become increasingly tarnished. Policy makers and NHS leaders have failed to understand the importance of general practice, not only for the million people that use its services every day (representing 90 percent of patient contacts with the NHS), but also its role in supporting the hospital sector to operate effectively.

Martin Marshall

But things are looking up. The GP Forward View (GPFV) in 2016 signalled a change in strategy for NHS England with promises of additional investment in staff and infrastructure. The ideas were sound, but it has so far failed to deliver a level of improvement that patients and health professionals can feel on the ground. The NHS Long Term Plan and the recently announced new GP contract build on the GPFV and together offer a promise of more substantive and palpable change.

The NHS Long Term Plan commits to increase investment in primary care and community health services by at least £4.5 billion by 2023/24. Depending on how much of this investment is targeted specifically on general practice, this 5-year settlement could increase the investment in general practice from the current 8.7 percent of NHS budget to the 11 percent demanded by the Royal College of General Practitioners (RCGP). The plan also makes a welcome commitment to rapidly building the non-medical primary care workforce and reaffirms the GPFV commitment to increasing the number of GPs by 5000, though it remains unclear how, and how quickly, this will be delivered.

With additional promises of support for the development of GP networks, investment in prevention, basic IT infrastructure and digital developments, a strong focus on person-centred care and support for new ways of consulting, the Long Term Plan represents a massive commitment to and vote of confidence in general practice.

But policy commitments mean little unless fully implemented and this is where the announcement of a new GP contract following lengthy negotiations between NHS England and the General Practitioner’s Committee of the British Medical Association (BMA) comes in. Contracts legally enforce delivery of policy commitments on the ground and the 2019 contract is the operational lever for change.

The contract puts detail on the Long Term Plan: £1.8 billion to establish GP networks across the whole of England by July 2019; 20,000 more staff operating at the level of GP networks, including social prescribing support workers to promote non-medical solutions to health problems; increased financial support to develop digital consulting; a stronger focus on continuously improving quality rather than just hitting arbitrary targets; a commitment to supporting the GP partnership model which offers remarkable value for money for the NHS; and the introduction of a new clinical indemnity scheme similar to that provided for hospital consultants.

Together, and if implemented in full, these initiatives are likely to make general practice a more doable and more enjoyable job, attracting the very best of new generations of health professionals and retaining the most experienced ones. And from a health system perspective general practice will be in a better place to play a leading role in the formation of locality-based Integrated Health Systems which are rapidly emerging as the new model for the NHS.

In recent years UCLPartners has made a significant contribution to the development of general practice across our locality. We have delivered leadership development programmes for members of the primary care team, supported the capabilities of general practice teams to undertake systematic improvement projects, and helped to develop general practice networks and integrated models of care. All of these activities have and will continue to enable general practice to respond positively to the opportunities provided by the Long Term Plan and the new contract.

General practice has been under pressure for so long, and has seen so many false dawns, that it is in no mood to publicly celebrate. But maybe, just maybe, the corner is about to be turned.

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