The current GP funding model ‘does not sit comfortably’ with NHS England’s plans for primary and community care integration, according to a senior NHS England director.
In a Lords Committee hearing today, NHS England’s national director of primary and community care services Dr Amanda Doyle said a ‘rethink’ was required with regards to the primary care estate, with ICBs tasked to draw up local plans.
Asked whether the GP partnership model was compatible with integration, Dr Doyle told the committee that this was ‘one of the challenges’ they are facing.
She said: ‘One of the challenges that the current predominant ownership model in general practice gives us is that both investment and revenue flows support that model [of] an individual, practice-sized building.
‘And lots of the things we want to do as we move forward into co-located primary care services and scaled-up primary care delivery drive the need for bigger premises with a wider range of capacity, and those two models don’t sit comfortably together.’
She added: ‘There’s also an argument that a younger generation of GPs [are] less keen to jump straight into partnership including building ownership and all the risks that brings.’
She confirmed that each Integrated Care Board (ICB) is currently preparing a strategy for its own estate.
Asked if too much money is being spent on hospitals currently, Dr Doyle also told the Committee that ‘we absolutely need to rebalance’ the capital investment differences between secondary and primary care.
‘There is no doubt that as we expand our thinking about the capacity needed in primary and community services to serve a population who will be much more reliant on preventative but also care for long-term conditions and increasing frailty out of hospital in people’s own homes, as well as the expansion of things like virtual wards, where we’re delivering care in the community rather than in a traditional hospital bed.
‘That is going to drive us to a greater consideration of what the capital, estates and IT infrastructure out of hospital both in primary care and community care services need to be,’ she said.
When it comes to staffing struggles across the country, Dr Doyle also admitted ‘there’s no doubt’ NHS England ‘needs to do more to retain more experienced clinicians’ on top of efforts to attract more GP trainees.
In answer to a question regarding the statistic that 23.2% of general practitioners work full-time, although she highlighted that this could be due to a multitude of reasons – such as parents choosing to work part-time, doctors having portfolio careers or reducing their hours towards the end of their careers – she added that ‘we can’t ignore the fact that alongside all of that, there are people who are finding the job, the workload, overwhelming, the demand is overwhelming, and they are choosing to adjust to that by working less than full-time’.
Dr Doyle acknowledged that it was key when implementing the primary care recovery plan to create ‘a future where general practitioner is a job where people can manage the workload, do what they were trained to do, it’s a satisfying job and they want to stay doing it for 30 years’.
GPs in the UK experience the highest levels of stress and have the lowest job satisfaction compared to doctors in other high-income countries, according to a recently published report, while more than one in five GPs aged under 30 quit the profession last year.
Labour Party leader Keir Starmer has said the GP partnership model is ‘coming to an end of its life’ and that the NHS needs ‘more salaried GPs’.