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Analysis: Hunt’s plans to reform primary care take shape



Jeremy Hunt was expected to bring calm to the NHS after the tumultuous events of Andrew Lansley’s tenure at Richmond House. The reality, however, has been very different.

After a series of set-piece speeches that offered only dark hints of what he had in store for GPs, he has finally put some meat on the bones of his plans for ‘profound reform’ of general practice in England.

The political message hammered home throughout a summer of sabre-rattling was clear: that the 2004 GP contract had been ‘disastrous’ for the NHS. But now he has begun to spell out the detail, outlining in a landmark speech at the King’s Fund last month a series of major contractual changes he wants to see in place by April.

These include GP’s new responsibility to be a ‘named clinician’ leading on 24/7 out-of-hospital care for elderly patients, a major reduction in ‘box-ticking’ targets and the creation of electronic care plans for vulnerable patients.

Mr Hunt has also made the case for a shift in funding towards GPs and has echoed the RCGP’s recent call for more GPs to be trained.

He has indicated that his ‘named GP’ plans for the elderly represent the first year of a four-year focus on improving the care of vulnerable older people, those with long-term conditions, mothers and young children, as well as preventive medicine.

Mr Hunt also claims to recognise that GPs ‘work hard and need time off’ –although the profession has every reason to be sceptical after the imposition of the onerous GP contract in England this year.

GPC negotiators say there is some ‘shared ground’ with Mr Hunt’s proposals, but stress that the current workload pressure on GPs must be eased if they are to adopt a wider remit.

With NHS England also conducting wide-ranging revisions of the QOF, the Carr-Hill formula and other practice funding streams – and even talk of a brand new GP contract in the offing – GPs are bracing themselves for an unprecedented shake-up of practice funding next April.

As ministers and GP negotiators gear up for what could prove to be a decisive round of contract negotiations, we look in detail at what Mr Hunt is asking for – and whether it can really be delivered.

Jeremy Hunt plans graphic - online

What do GP leaders think?

We believe that we have a lot of common ground in terms of aspirations for patient care, but ultimately what needs to be addressed are the obstacles that are preventing GPs and practices from developing and expanding their services. We are looking forward to direct dialogue with the Government to enable GPs and practices to deliver some of these common goals.

Dr Chaand Nagpaul, GPC chair

This is a real chance for a renaissance of general practice – for the service to focus on people rather than diseases, move away from the tick-box culture of the QOF and get back to our values and our professional roots.

Dr Michael Dixon, NHS Alliance chair

This will not end the crisis in general practice. We urgently need a clear commitment for sufficient funding to enable general practice to deliver more services for patients.

Professor Clare Gerada, RCGP chair

The named clinician is essentially what general practice should be all about, which is a sense of community and ensuring population health. But we have been encouraging a decluttering of primary care so that GPs can deliver this.

Dr Charles Alessi, NAPC chair

Read more: Analysis: How the Government’s blueprint for the scheme will work

Devolved nations go their own way

For the first time, the four UK nations will have separate contract talks this year, in a move that signals the end of the UK-wide GP contract from next April.

Following the breakdown of contract talks last year, the governments of the devolved nations have decided not to mandate NHS Employers to represent them in negotiations over the GP contract, although the Welsh Government has charged the body to negotiate its QOF terms only.

The move comes despite the GPC’s determination to maintain a collective approach to negotiations and will mean that the devolved nations will be free to offer radically different terms to negotiators, rather than merely adjusting a UK-wide deal as in previous years.

The Welsh Government is likely to want increased access and progress on phasing out the MPIG, while the Welsh GPC is likely to focus on GP retention and recruitment and blocking the introduction of NHS 111.

The Scottish Government is set on integrating health and social care and avoiding any increase in health spending. But the GPC will push for as little contract change as possible and for GPs to have a say in commissioning integrated health and social care.

The Northern Irish Executive is likely to want to push ahead with its ongoing Transforming Your Care programme, while the GPC will argue that the QOF should be cut back to free up funding to care for the frail elderly.