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At the heart of general practice since 1960

Forget the hype, but the 'forward view' is a significant shift

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I was invited to speak with NHS chief executive Simon Stevens last week to discuss his plans for general practice. 

Perched on his purple sofa, I was plied with questions on what I thought about GP recruitment, workload and funding. As someone who likes asking, rather than answering, questions, it was an odd meeting. 

We covered a lot of ground, and I did not hold back on my criticism of the NHS to date in its handling of general practice. I was asked to come up with some immediate solutions, and you can get the gist of what I said here. I came out of it none-the-wiser as to what Mr Stevens was going to propose - he kept his cards very close to his chest - but I was clear about one thing: he was taking the whole plan very seriously. 

Now we know all the details, no-one can doubt his ambition. 

Additional recurrent funding of £2.4bn for general practice by 2020 is a massive sum and a whole lot more than the £110m that was proposed previously. Add in the CQC inspectionsbanning hospital workload dump and - as I suggested to Mr Stevens - a promise to protect GPs from rising indemnity fees, and we have the first signs of real progress. 

The real piece of unequivocal good news is that all GPs suffering from burnout will have access to funded mental health support by December  – a significant Pulse campaign win and something we have been calling for since 2013. On top of this, a £500m ‘turnaround package’ for struggling practices that Pulse has been arguing for through its ‘Stop Practice Closures’ campaign is also most welcome. 

But is this really the ‘most significant announcement for general practice since the 1960s’ as claimed by the RCGP today? Probably not.

It lacks clarity and – as many grassroots GPs are complaining – it does little to help practices right now. NHS England is well known for snatching defeat from the jaws of victory and it is becoming clear that the delivery of these new funds will take time and GPs will have to jump through multiple hoops to access them.

A great deal is being poured into schemes to boost the contributions of the non-GP workforce, perhaps an indication of concern that the shortage of GPs will continue. As far as we can tell, little or none of the money is allocated to core funding of GMS practices and the £500m of ’transformation’ funding looks destined only for those who sign-up for seven-day access.

At best, these measures may prevent a run of GP practice closures that could have destabilised the NHS and brought the whole service to the brink. It will deliver some breathing space over the next few years, but there is no radical redrawing of the GP role, so expect the pressures on the system to continue to increase. 

GP leaders clamouring to try and take the credit for this deal should be very careful not to let their short-term enthusiasm cloud their long-term judgment. It may keep the show on the road for a few more years, but if general practice is to survive then something more ambitious is needed if the profession is to truly have a compelling ‘forward view’.

Mr Stevens has played a good hand, but I hope it is just the beginning.

Nigel Praities is editor of Pulse

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Readers' comments (10)

  • Azeem Majeed

    Sound advice Nigel.

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  • Dr David Barrett

    Indeed an insightful summary. NHSE needs to give more practical genuine rescue packages to fix the "current view", not just a "forward view". Here & Now please!

    I like analogies:
    If I wanted to fix my roof by 2020 I'd be stupid to let it collapse a bit more right now, be forced to build a superfluous conservatory extension first, heat & light the place for 7 days on 5 days of funding. As the years progress not being able to source skilled builders to do the work would be a worry.

    And if my "core building" was collapsing, I'd hardly be inviting all my friends and family around to sit on the sofa with water dripping from the ceiling. Primary care needs it's roof fixing now because the Sun hasn't be shining for 10 years...And don't even ask me how much the insurance premiums are personally costing me.

    We're heading in the right direction but can't help feeling it might be too little too late.

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  • A move in the right direction to sustain integrated Primary Care in collegiate groups with 21st century premises instead of "cottage industry" small Practices in leaky Edwardian semis, but no solutions to ever-rising demand from patients.If the bath is overflowing, turn off the tap not design a better plug-hole.
    Until politicians wean the public of their addiction to universal free health care we are whistling in the wind.
    We must have support from government, the media and society at large to run a system that addresses patients' needs and not their wants.

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  • So why ,exactly , can't indemnity be funded by the state ? It would give income a lift and boost OOH immediately .

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  • I hope u guys are still playing the mass resignation card. The now 'rescue package' is bullshit.

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  • Its just a game of poker, init?!

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  • World GP shortage saved by Hunt and Stevens, except for in England.

    Nigel- you could have just told him he was effing mad

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  • Bring it on- Obama will cause our salaries to rise to match those Stateside- cashmere cardies for all!

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  • Vinci Ho

    Nigel, if what you said about reductionist and expansionist is right , this situation represents a 'prisoner dilemma' in Game Theory:
    'Co-operate' is going along with this package for five years forward view. 'Defect' is not co-operating.
    If both reductionist and expansionist co-operate , the reward is R.
    If both defects , the reward is called punishment payoff, P
    If one co-operates and the other defects , the former will receive temptation reward , T, and the latter will receive suckers' payoff , S.
    In terms of size of different rewards , it remains according to the theory :
    TRPS
    Only a theory....
    Of course , all giving up to play the game, hence, resignation is always there........

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  • Vinci Ho

    T more than R more than P more than S

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