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Independents' Day

In full: NHS England consultation on the future of general practice

Read a summary of the main points and download the full consultation document on the future of general practice in England.

What are NHS England suggesting?

  • Defining high quality general practice and GPs’ responsibilities and accountabilities through the GP contract
  • Adding stronger incentives for inter-practice collaboration and collaboration with other providers in primary, secondary and social care into the contract
  • Changing the contract to better recognise and reward quality of care for patients with co-morbidities and complex health problems
  • Rewarding practices for wider outcomes such as enhanced quality of care for long term conditions, reducing avoidable emergency admissions, reducing incidence of strokes and heart attacks or improving patient experience of integrated care
  • Looking at how PMS and APMS contracts can help address local challenges
  • Introducing a named GP for patients with complex needs
  • Strengthening accountability for the quality of OOH services, and ensuring they are more integrated with daytime general practice and wider urgent care services.
  • Stimulating more convenient routine access to general practice services through improving the speed of contact for urgent problems, the ability to book appointments in advance and electronically, and making evening/weekend appointments more available
  • Developing QOF to preserve its essential features but reducing the ‘tick-box’ culture feel
  • Reduce process-orientated measures and get the best value from enhanced services
  • Developing practice IT systems to support more efficient and integrated working
  • Ensuring practices are making the most effective use of practice staff, including practice nurses and practice managers.
  • Getting practices to publish an increasing range of comparative public information
  • Looking at workforce issues and the strategic priorities for improvements in education and training to reflect modern general practice

Readers' comments (10)

  • The most obvious "Elephant in the room" which hardly gets a mention other than "reviewing existing NHS stock and freeing up resources" is GP premises - premises are the key to leading a rejuvination of UK General Practice (forget all this joined up "Primary Care" twaddle that was the swan song of PCTs - 10 years of "Primary Care" was all about developing community Trusts).

    Modern spaceous premises with GP computer software (not this american health maintenance based community nurse - the dying PCTs hoisted on us all as dosey GPs under the radar as "shared" - why didn't they share our GP software - why did we have to dump our GP systems developed over last 20 years for their new nurse systems?)

    GPs as independent small business's has been the driving force behind General Practice - registering patients with practices rather than individual GPs was all to do with the "Managers" leading GP practices agenda of the old PCTs - stop Drs being in charge and have managers instead. Federalisation is just more of the kick the GP leader model - to GP employee.

    Salaried service with Managers in charge - mpphh now where's that worked well ? Hospitals. Why are we letting this happen to us? Does nobody care anymore?

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  • We had enough changes.Time we stood up and vote with our feet.

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  • God help the lot of you: it seems unlikely anyone else is going to.

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  • So as I see it from looking at the document they want us to do more weekend work, be responsible for Complex patient discharges at any time, be paid according to outcomes no matter who has been treating them. They want to develop QOF more, give more power to patients, reduce bureaucracy by getting us to produce more comparative data and boost CQC and the new GP Inspectorate. They also at the same time want to open it all up to AQP.

    What's not to like? Should have the new recruits dashing to join. Just include a pay and resources cut and the problems will all be solved.

    Thankfully I am now in my 50s. Last one switch off the light please.

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  • The real 'elephant in the room' is that all these changes are being discussed but money is never mentioned. It is truly frightening to think that such an august body should even be considering introducing 24/7 working in general practice again without any increase in funding. The solution here surely must be to invest in general practice - invest money to allow practices to develop reasonable premises and take on new partners so that the increasing wokload can be handled without damaging that most important of resources - morale. I would have no qualms about taking on evening or weekend work again, looking after our own patients 24/7, if it were as part of a reasonable shift system. But the money is not there to allow us to do that.

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  • The tone of the "consultation" gives a clear message about the underlying goals.
    1. Turn healthcare in the UK into a consumer led market.
    2. Engineer routes of access (and exit) for future (and current) providers.
    3. Privatise healthcare.

    Good or bad it's going to be an intentionally rough few years. There is a "J" shaped curve theory in transformational change - a system needs to be destroyed and fall to pieces before a new system develops (a little like in civil war). The disarray that occurs at the bottom of the "J" encourages a new system to develop with less opposition.

    Calling the consultation exercise a "consultation exercise" is however a little misleading. This whole exercise is in fact already a direction of travel, aiming at the above goals.

    Get ready to hit rock bottom over the next few years and then find a niche, which will be highly profit led, in the next 5-10 years.

    Patients with money will have their round the clock personal doctor.
    Patients without money will end up with a second rate service.

    The sad thing about this is it's completely avoidable. If as a population we were more encouraged to live healthier lives with a sense of health aligned to the "human condition", the diease prevalence would reduce, the market for drugs with large NNTs would reduce, and the health spend would fall. Tie this in with the halting of the active campaign by politicians informing the electorate that they are entitled to an extremely expensive heathcare system, and we could have a quality affordable NHS. Unfortunately there may be too many commercial drivers and influences to allow this, and there is not enough tax payers money to provide it. Thus privatisation is on the way.

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  • Guess what the dentists did? My profit per patient consultation[ take home] is £2.66. Work out yours - if consultations are 60 % of workload - if you can do better than £ 4.00 you will be lucky.
    Why do we stay ? They want the earth for £2.66. Goodbye.

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  • Looking at this lot it's fairly obvious the time to move to private fee for consultation general practice is now.

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  • Surely this consultation document should be being distributed around europe and the countries in the middle east and India from where most of the doctors working under it will have to be recruited?

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  • No mention of investment in Primary Care. No mention of increased staff and the cash to pay them !
    More hours are impossible without this.
    No mention of the family role of the GP, continuity or holistic care.
    Still secondary care dominated I'm afraid as always.
    Dr Chand Nagpaul has a mountain to climb. I wish him well

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