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At the heart of general practice since 1960

GPs are not 'crying wolf' about pressures, says NHS chief executive

GPs are willing to consider 'radical' changes to their model of practise because they have been 'systematically under-invested in', NHS England's chief executive has said.

Simon Stevens said that general practice in England will change, away from the 'cottage industry', with new models including hospital takeovers and GP super-practices.

And he said these changes were made possible because GPs were 'willing to contemplate some quite radical changes', but he admitted that this was a direct response to under-investment and NHS leaders placing 'rising workload and demands' on GPs.

Asked by the House of Lords NHS sustainability committee whether it was time for hospital trust to take over the running of general practice, Mr Stevens said: 'In a nutshell, I would say general practice is a flotilla, not an aircraft carrier and so it will develop in different ways in different parts of the country.'

He added that 'we are going to see a mixed model in the way in which primary care develops' across the country, depending on issues such as local leadership.

And, seemingly admitting that GPs had been given little choice in the matter, Mr Stevens said: 'My reading is that GPs are not crying wolf. Actually they have been systematically under-supported and under-invested in, relative to the rising workloads and demands that we are placing on them.

'And that because, frankly, their backs are against the wall, they are now willing to contemplate some quite radical changes to the way in which general practice operates.'

But he said the new models would be 'maintaining the best features of it, including list-based continuity of care for populations and the personal relationship for those patients that want it'.

And he argued that the wider range of changes NHS England is pushing through within the health service at the moment did not amount to another 'top-down reorganisation' - something the Government had promised the electorate that it would not do.

Mr Stevens said: 'Rather than a new Big Bang top-down reorganisation, which I think would have most people in the health service jumping off a cliff, we are trying to do this organically.'

His comments come as Pulse recently uncovered an internal NHS England memo which said vulnerable GP practices must ‘transform…or be allowed to fail and wither’ although at the time NHS England denied that this was their national policy.

Partners jumping ship

As a Pulse analysis outlined in July, NHS England’s Five Year Forward View is quietly driving a move among practices to hand back their contracts, with GPs willing to work in salaried roles for foundation trusts, GP federations or under the ‘new models of care’.

And in Scotland and Wales, health boards are increasingly taking over contracts – and practice staff – when retiring partners cannot be replaced.

A Pulse survey revealed over half of partners would consider going salaried - a massive shift from just a few years ago.

Decreased funding, increased demand, the advent of CQC inspections and widespread problems with GP recruitment, among many other reasons, have significantly reduced the appeal of the traditional partnership model of general practice.

A BMA survey of 5,000 GPs has - as we report - shown that the support for the independent contractor model remains the most favoured option, although the fact that a third of respondents favoured other options would have been unthinkable not too long ago.

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Readers' comments (25)

  • "systematically under-supported and under-invested in"- he keeps on saying this as if to expiate. If he believes it why doesn't he do something about it? My practice only keeps afloat because we have sacrificed income to employ staff to do the work of the local trust and because in a leafy N.London suburb I can just about find partners to work 12 hours a day for less pay than the practice manager. Get rid of the CQC , emasculate (literally please) the GMC, ban the prescription of OTC medication, pay indemnity costs give us a 15% across the board pay rise and then we might , just might save the NHS. Otherwise "systematically under-supported and under-invested in" will be your epitaph Mr Stevens.

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  • "Asked by the House of Lords NHS sustainability committee whether it was time for hospital trust to take over the running of general practice"

    General Practice is one of the few pieces of the NHS that manages to live within its budget and out-perform its targets, supported by the altrusim and self-sacrifice of its staff. Hospital Trusts are proligate, disorganised, and would destroy primary care as they have done with all other community services: district nursing, health visiting, mental health.

    GPs are not so much 'backs to the wall' as 'buttocks bared'

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  • It is a "high risk" strategy ie deliberately crushing General Practice to force through changes that are perceived to be of benefit.

    Good Luck Stevens-this is, indeed "The Fool's prophecy".

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  • Dear All,
    So lets see the money then. So far there is circa £300 million over next 4 years for general practice in the 5YFV. Annual spend in general practice is £8 billion.
    Do the maths. This is not even beginning to correct the systematic disinvestment of general practice. Yes workload can be helped by changes in working but these are all nibbling at the edges, not having to re-refer a few patients, issue a few Med3s or set up a brand new set of medication for a Friday afternoon discharged patient will help but it will do nothing against the real problem which is the step change in patient expectation that has occurred over the last decade. This is not just the NHS's problem, not just Politician's stoking up demand but a wider societal change, the "mine and now" generation.
    To deal with this we need a massive onvestment of resource so we can employ the hands we need to manage this demand. Not more profit for GPs, more resources. And no I don't want someone seconded, because their paymasters are part of the other problem which is the overregulated collective loss of confidence suffered by NHS managers who can never make a decision about anything unless told by someone else. We need staff we employ, we direct, we manage and we take the can if it goes wrong.
    Regards
    Paul C

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  • Mr Mephisto

    This is not a "top-down reorganisation" or "bottom-up reorganisation" it is not a reorganisation at all - it is a "bottoms-up" collapse of the service.

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  • "Not more profit for GPs, more resources" says Cundy. Well let's make this clear - he is not speaking for me or the vast numbers of young doctors who look at the work/ reward ratio of current gp and walk along the other side of the road. More profit will put bums on seats - maybe Dr Cundy hasn't heard of N Ireland? I can't bear this pseudo-altruism.

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  • Dear 3:10pm,
    So at the moment you earn £X and work your butt off. Magic wand and you still earn £X but now have Y minions who you delegate to and they do the work. Tell me what part of the work life balance is not changed?
    Regards
    Paul C

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  • A virtual nobody

    Job done it seems, crush them until they are completely broken, and then impose anything the health secretary wants. Hunt must be delighted. A stinking pile of dictatorial top-down crap. Makes me sick.

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  • Dear All,
    Yep, makes you want to throttle them doesn't it. Its worth re-reading what he said, these are his words;

    'My reading is that GPs are not crying wolf. Actually they have been systematically under-supported and under-invested in, relative to the rising workloads and demands that we are placing on them.

    'And that because, frankly, their backs are against the wall, they are now willing to contemplate some quite radical changes to the way in which general practice operates.'

    what a nice man to work with.
    Regards
    Paul C

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  • Pay them and they will come . Pay them not and they will go to Australia .

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