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Can the Forward View revive general practice?

Professor Martin Roland says this document is a real watershed while Dr Stephanie de Giorgio warns the package is too late and has too many strings attached


Well there’s one thing about GPs – you’ll always find someone to be grumpy however good the news is. And this news clearly is good. It’s not just the extra £2.4 billion for general practice, or the 3,000 extra mental health therapists in primary care by 2020, or the £112m for 1,500 pharmacists working in general practices. More importantly, it signals a sea change in the way NHS England sees general practice, clearly indicated by NHS chief executive Simon Stevens’ introduction to the package, when he says: ‘There is arguably no more important job in modern Britain than that of the family doctor’. I think they are starting to get it.

This new workforce won’t arrive immediately, but NHS England has thought about trying to reduce our workload too. So a new standard contract for hospitals will reduce the amount of work being dumped on general practice, by stopping automatic discharge of patients who fail to attend hospital appointments, removing the requirement to refer back to the GP if another specialist’s opinion is needed, and setting standards for specialists to communicate results to patients and GPs. It really starts to look like a comprehensive rethink.

CQC inspections will now be five-yearly for more than 85% of practices. And – this surprised me – there’s an extra £16m for mental healthcare for GPs; not that it’s not needed, but that Government is prepared to admit the huge stress GPs have been working under.

Of course this won’t happen overnight, and next week won’t suddenly be less stressful than last week. NHS England has made a huge number of promises it now has to deliver on – and be held to account for. But this package exceeds what either the BMA or RCGP could have hoped for, and I think it will be a real watershed for general practice. If general practice thrives then we really are on our way to a world-beating healthcare system. Then medical students will want to be GPs, and young doctors will want to be our trainees, and a few older doctors might even decide to stay on a bit longer.

Professor Martin Roland is professor of health services research at the University of Cambridge. He was a GP for 35 years


This is not going to rescue general practice. Not general practice as we know it anyway.

No one disputes that it is good to have the GP state of emergency recognised by policymakers, but it’s about five years too late. The dominoes are already falling.

The package does contain money. Somehow £2.4bn has been found behind NHS chief executive Simon Stevens’ sofa. However, it appears to be from the £8bn already promised to the NHS, so someone else will lose out. Transfer of funding from secondary to primary care is welcome, but trusts already have huge deficits, so how will they cope?

What we have needed all along, is an immediate, large investment into the global sum. GP practices have proven themselves efficient and smart users of money. Don’t make us jump through bureaucratic hoops to get funding, or use precious time redesigning services that work already and don’t insist on seven-day opening to get this money. Trust us to use it wisely and just give it to us now.

As expected, this plan is based around working ‘at scale’ and all its perceived benefits. Yes, there are definitely some, but a lot of this money is being spent facilitating this change. GPs don’t have time to wee, let alone plan new ventures. Some vanguard sites are doing well, others are floundering; it’s not a panacea and I worry the importance of smaller, well-run surgeries is being forgotten.

There are some good points in the plan, such as funding for pharmacists, paramedics and training up admin staff. The guidance on secondary care work is helpful, but shouldn’t be needed. Improvements to the returners scheme are welcome, although I have heard it isn’t working in practice as no one seems to understand it.

Will the rest of the Forward View rescue general practice? I don’t think so. The money may or may not be new, but it doesn’t even take us back to historic funding levels and we’ll have to do more work and look after a significantly more medically complex and dependent population. What we need is enough money to do what we do now, but better, That would be the basis of a real rescue package.

Dr Stephanie de Giorgio is a GP in Kent and a co-founder of Resilient GP


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Readers' comments (11)

  • Harry Longman

    Has Simon Stevens been reading William Osler? " “The cultivated general practitioner: may this be the destiny for a large majority of you. You cannot reach any better position in a community." Well said. This is a huge boost for GP and I'm with Martin, but Stephanie raises an important point on smaller surgeries. Their should be no discrimination, and I'm afraid the headlong rush for scale is without an evidence base. I've just discovered the best ever performing practice in 5 years of work, and it's a single hander with 2,700 patients.

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  • Stephanie is right to worry - it's a bit too little, far too late and Professor Rolands is conveniently glossing over the glib statements about more staff: they don't exist (3000mental health workers?? My local Mh trust has 20/25% posts unfilled) and still won't in 5 years time.

    Big numbers have generated the headlines but they are often re-badged monies or filched from somewhere else, and very little is going to appear in our Practices for us to use sensibly as far as I can see. The test will be if u can recruit for October and the NHS income balance sheet in my accounts next April. If we have no new doctor and no increase in that balance, Simon Stevens words will mean nothing.

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  • From what I have been told in the last few days it seems that the 2.4 billion has already been allocated and spent and CCGs are going to be told what to use it for as they already are in deficit with new initiatives like mental health so it seems that WE in primary care are not going to get any of it ! false hopes it seems we are no better off.

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  • it will be spun that GPs are getting 2.4 billion which will be going straight into GP's pockets.

    the reality is it will all be misspent on political pet projects as per usual.

    we will get the blame for NHS failings as per usual and take another hammering in our T&Cs.

    the GPC will stand idly by. when prompted we will hear award winning speeching backed up with no action and we will be told 'its better than nothing' or 'the only other option is to leave'.

    leaving is the best option.

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  • Vinci Ho

    Take the argument one cannot complain all the time for the sake of it , even when some 'real' promises are made.
    But fundamentally it is still about evidence and trust , no matter how respectable the ideology is. To have positive outcome in the equation of recruitment and retention , people , old and young , have to be convinced and believe this will really make a difference . And the first step is always the hardest : all to see what Stevens (forget about Hunt) can really do immediately to restore trust with hard evidence , only then the train will move in a positive direction . At the moment it is moving opposite way .
    Harvey Dent is Two-Faced. He has the choice to choose which one to turn to us.

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  • The professor WAS a GP - he has no idea what frontline GPs face today. It is a matter of workload,morale,burnout,stress and no frontline GP will see any difference on this "forward view"

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  • If they had just increased the global sum per Patient they would have needed to spend hours thinking about it and coming up with 80 page documents and all the money needed to do that. GPS would have been happier, morale improve, which would knock on to improve recruitment. Why do they always have to complicate things? Maybe because if it were so simple none of them would have a job?

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  • I think there will always be people who will become doctors in the face of imposed Contracts, 90 hour weeks etc.
    Equally, there will always be people who become GPs in spite of 40-50 consultations, 13 hour days, CQC, GMC and all the pasting in the papers 'lazy, greedy GPs', the 50% reduction in pay in and the approximate 40 % reduction in share of NHS spending in 10 years 11.2 to 7.2%].
    The last fact underlines and delineates to any outside observer the utter contempt of the the Govt for General Practice, a fact that people like the Professor just ignore in their analysis and complain that GPs are moaning !!
    Anyway, there will always be GPs who ignore all this and get on with work.
    But enough to sustain General Practice ? Maybe.

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  • I have been a GP manager for 21 years so I know the nuts and bolts of the business very well. I think Prof Roland is too far removed from the reality of it by now. He talks in glib headlines with seemingly no understanding of the harsh realities of the details - and whether or not something works is all determined in the details, not in wishful headlines. I have seen absolutely no details in the "rescue" package that will do anything to rescue a system which in my opinion has now been driven beyond the point of no return.

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  • What General Practice?
    Oh- the one that used to have doctors and nurses, D/Ns and HVs.........and was bloody good's gone mate

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