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A faulty production line

GP Forward View was redundant before it even started

Dr Kailash Chand

A new analysis by the BMA has found that NHS England’s GP Forward View pledge to bring GP spending to 11% of the NHS budget will not be met, with the share to stand at just 8.4% by 2020/21.

Last year when GP Forward View (GPFV) was published, there was a degree of scepticism amongst many GP I spoke to. GPs have seen promises and pledges rolling off the political conveyer belt only to find they end up being empty. The trick of recycling money for announcement after announcement has worn down the goodwill of many doctors and patients to the point where cynicism is understandable. A repeated commitment by Hunt & Co to restore an adequately resourced national GP service is proving to be just a political gimmick.

The GPFV report by NHS England chief executive Simon Stevens promised a series of measures aimed at tackling the mounting crisis of workforce, investment and workload. It promised to increase funding for general practice that would bring it back to roughly the 11% level that it had been for much of the last decade. In addition to this, it promised plans for an expanded workforce, to tackle the avalanche of paperwork and a rescue package for practices facing collapse.

It also promised support to GPs who are buckling under this strain, with services to tackle burnout and stress, as well as providing practices with a range of other professionals, such as the 1,500 new pharmacists working in practices to share some of the workload on overstretched GPs. It contained desperately needed proposals to empower patients to play their part in appropriate use of GP services, with a national commitment to self-care.

But has anything materialised? Sadly nothing! Instead, there is plenty of evidence that GP services have sunk to a low ebb. The NHS now has the distinction of having the most stressed GPs by western standards, as a result of relentless workloads, endless bureaucracy and the shortest amount of time spent with patients.

GPs and their staff are working harder than ever before and this relentless pressure is taking its toll. A recent BMA survey showed that almost nine of out ten GP practices felt that the sheer amount of pressure they are under is having a detrimental effect on the service they give to the public, while up to a third of GPs are planning to desert the NHS in the next five years. More than 300 GP practices across England recently reported to the BMA that they felt their long term financial prospects were bleak and they may well be forced to close, leaving tens of thousands of patients without a local GP practice.

Has anything materialised? Sadly nothing!

In this climate it is unsurprising that many of the next generation of doctors are turning their backs on a career as a GP, with more than 600 GP trainee vacancies left empty last year: exacerbating the problem as there are even fewer staff to deliver the appointments that our unhealthy, ageing, expanding population needs.

It appears that with the advent of new care models, such as devolution in Manchester, integrated care organisations (ICOs) and the development of accountable care organizations (ACOs), Mr Stevens’ GPFV, a proposed recipe for NHS’s ills, is redundant even before it has started working.

The gap between policy rhetoric and supply reality has never been starker. It is obvious the future of primary care services and GPs will be at the mercy of either local authorities or foundation trusts. 

Dr Kailash Chand is a retired GP from Tameside and is honorary vice-president of the BMA

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Readers' comments (7)

  • and....
    i dont disagree but really only the first paragraph of this adds any new info. what has the bma done to help? found us cheaper insurance? helped us find more doctors? helped us in any way?? advertising in the bmj gets more and more expensive.. what does the money get spent on?

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  • Tom Caldwell

    Not only was it redundant before it started it was never the right answer to the question in the first place. It was doomed to fail as it never answered the problem even if fully implemented

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  • Vinci Ho

    Any ideology is only meaningful if the ruling party has enough political power and energy. One day of politics is too long and three months after a general election easily represents a pass of 'centuries'. Latching on an old rhetoric goes from hero to zero. A foreign secretary's proclamation of giving NHS £350 million a week after reaching the destiny of Brexit is a very good example. Good him some credit , he spent 4000 words in article to promote his ideology,
    Instead , the government is to make different kinds of concessions in order to earn back credibility bitcoins. Lifting the cap on pay rise in public sector and halt on the rise of university tuition fees( chancellor suggested to reduce that to £7500 per annum) are only the beginning of a new chapter, in my opinion.
    Thanks to the arrogance of the prime minister when she presumed that she would gain more political energy jumping onto the bandwagon called ' Chariot of Brexit' and welcomed all the hard core Brexiteers into her realm. Well , that was then , this is now .
    Triumph because of Brexit ; Defeat because of Brexit.
    The prime minister is now too busy in re-asserting that she is ' the one in charge' , effectively trying to keep some distances from these Brexiteers. Even Mr Davis has fallen out of favour as her patience is drying up.
    This is perhaps one of the lowest points of British politics in recent history when nobody seems to be able to convince the public that he or she knows what to do for the best of the country. I suppose no one likes to be the leader in a mess ( explains why Auntie May still in position) but anybody can imagine becoming the prime minister (explains why Uncle Cable with his dream).
    As far as we are concerned, a weakened enemy can only be an opportunity for our lieutenants(if they have wakened up ). All these pledges and plans pushed forward before the general election can all be easily forced back onto the drawing board if we play the game of minds correctly.
    To me , the nasty party has become the immoral party . Their infightings and backstabbings are macabre. One day, someone might report to the police that different pieces of Auntie May were found in somebody's fridge .Who knows?
    By the way , where are you , Sarah?

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  • Vinci Ho

    Give him some credit , he spent 4000 words in an article to promote his ideology.

    On second thought , he might have been the most loyal servant of our JAM(just about managing) prime minister and deliberately made a fool of himself in the public . Hence , she was granted a golden opportunity to tell everyone that only she was driving in the front !

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  • No GP wants to be part of an ICO or ACO, apart from those GPs who see it as a means of becoming involved in management and earning more money. For the rest of us it looks like hell.

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  • Just Your Average Joe

    BMJ should make job adverts last until post filled for 1 fee - if practices renew it by confirming post unfilled still.

    That would be helping - not a lot, but more than seems to be happening, and probably help lots of practices who can't actually afford to continue to advertise for unfilled posts due to cost being prohibitive with such limited return.

    We had no responses to the advert we put out - and we are in leafy areas outside london

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  • Just Your Average Joe

    At least online - as this is free for the BMJ online, although I understand printing space issues may make this impractical in the actual journal.

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