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A faulty production line

The glaring holes in NHS England’s proposals for general practice

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First revealed at Pulse Live, and finally published today by NHS England, there is a lot to digest in its public consultation on the future of general practice.

The document is very wide-ranging and is the first indication about how the new NHS governing body aims to reform primary care.

It raises a myriad of questions for public discussion that could involve a lot more work for GPs, for instance whether to provide more appointments at weekends and evenings, introducing a ‘named GP’ for patients with complex needs and getting the ‘best value’ from enhanced services.

But it contains some ideas that GPs will welcome, such as shifting resources from secondary care into the community, incentivising good care for patients with complex needs and making QOF less ‘tick-boxy’ – as first revealed in Pulse in May.

Incentives to help practices work together more effectively, and with other parts of the health service, are also likely to be welcomed as a counter to the fragmentation seen following the Health and Social Care Act.

But the most interesting thing - as Dr Nigel Dickson points out - is what the document misses out. There is little mention about practices in deprived areas – except for targeting ‘new entry’ in those areas (read ‘private providers’) – or revamping GP premises.

It also does not address the myriad of regulatory paper-shifting from CQC, revalidation etc. – surely one of the biggest GP time-sinks at the moment. It fails to properly address problems of GP retention and burnout – surely this must be a priority if NHS England wants a motivated and capable GP workforce.

But the cautious welcome from the BMA and the RCGP is telling. They welcome a discussion about addressing the pressures on general practice, as they know it is an argument they can win.

Nigel Praities is the deputy editor of Pulse magazine.

Readers' comments (2)

  • Phil Yates

    We must be brave about the future of general practice. The current model, which I've enjoyed and worked with for 30 years, is clearly not sustainable. GPs are voting with their feet - retirement or emigration - with potential young applicants choosing hospital medicine over the community. If we do not have a strong cohort of GPs arguing vociferously for the importance of investment and reform for the primary and community sector the health service as we know it is in jeopardy. We must find a way to remove the oppressive weight of regulation and targets from each practice and create organisations of sufficient critical mass that these functions (which won't go away) can be done centrally, whilst allowing practice 'outlets' to offer the sort of individualised care and continuity that can successfully reduce our overdependence on the hospital sector and provide the services in the community our patients need.

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  • What we need to remember is that the NHS serves a purpose - it keeps people working and contributing to society. It's a profit centre, if you like (and before anyone asks - looking after the old and the young allows workers to focus on their work instead of worrying about them - the old and the young are part of our families and our society).
    So what will make NHS work? Well detailed studies comparing different models of healthcare in different US states show clearly that the GP-led model is more cost-effective - both better care, and lower cost - to the tune of around 3x over the whole of delivery of healthcare. If we don't have GPs, we run the risk of an NHS that is simply too expensive serving too few people, and the whole economy will collapse as too many people are too sick to contribute.
    So the future of GPs does need to be examined. But what works is a future where GPs are partners in the practice, where GPs stay put and gain the confidence of people. We need GPs who care about their decisions today because they will still be around in 10 years' time to reap the consequences.
    I'm sorry, private providers employing salaried GPs for as cheap as they can get them (nothing against salaried GPs, just not in this environment) results in high turnover, and no relationship with the patients.
    This time around, I just hope the government is listening to the GP voice. If you want the research, just email me.

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