The Government should be encouraging GP practices to form more super-practices in a bid to reduce their administrative burden, an influential report has suggested.
The Times Health Commission report, published today, suggests 10 reforms to the NHS and social care in order to create a ‘healthier Britain’ – including GP contract reform.
The commission included leading health figures such as former RCGP president Dame Clare Gerada and former health minister Lord Ara Darzi, and its report will be discussed by the health secretary and shadow health secretary at a conference tomorrow.
The report made a number of proposals to reform general practice, including a new GP contract to ‘ensure patients can get appointments in a timely fashion and protect continuity of care’.
And it said ‘super-practices’ are a ‘good way’ of sharing administrative work between several GP surgeries while also reducing the cost of back office functions, in the same way as multi-academy trusts have done with schools.
The super-practice model rose to prominence in 2015 when some practices came together to form lists as large as 275,000, and the BMA’s GP Committee welcomed the model in its vision for the future of general practice.
On workforce, the commissioners said a mix of GP partners and salaried GPs ‘should continue […] for the foreseeable future’ but warned the balance is likely to shift in favour of salaried doctors.
‘The new contract must prepare for this shift by incentivising more collaboration within primary care and between GPs and hospitals,’ the report said.
The focus for a new GP contract should be on health outcomes rather than box-ticking minutiae, with a smaller number of targets designed around patients, it suggested.
It also recommended that a new network of purpose-built community health centres should be built, starting in disadvantaged areas.
Other recommendations for general practice
- GP priorities should be set locally, with a greater share of the primary care budget distributed through Integrated Care Systems (ICSs) rather than from central Government;
- GPs must be encouraged to see the bigger picture of population health rather than just having their eyes on the ten-minute appointment schedule;
- GPs should be encouraged to be more proactive, working closely with the MDT, to take the NHS to patients themselves;
- Group consultations can be a good way to help people manage and reverse long-term conditions;
- Physician associates are welcomed but must be regulated by the GMC;
- The role of GP as the ‘gatekeeper’ to healthcare must evolve, with patients able to self-refer to a specialist for conditions such as dermatology and MSK problems;
- The barriers between primary and secondary care should be broken down, for example by GPs being employed by hospitals or consultants doing outpatient appointments in the community;
- Digital triage systems can quickly direct people to the right medical professional;
- There has to be a better public understanding of the services that area available, as well as an expectation that patients can often manage their own conditions.
Source: The Times Health Commission
Beyond general practice, the report informed by speaking to over 600 witnesses including doctors also recommended that patients have their own ‘patient passports’ via the NHS App to book appointments, view their records, and contact clinicians.
And it suggested the Government should write off student loans for doctors who stay in the NHS, and polling of 2,000 adults showed that a majority (67%) supported this proposal.
BMA council chair Professor Philip Banfield said it was ‘good to see the recognition of the workforce crisis’ within the NHS, but that the report ‘sadly fails to make the obvious recommendation of restoring doctors’ pay’.
On general practice, he said ‘we should not reinvent the wheel before getting the basics right’, pointing to the reduction in GP numbers since 2015 and the ‘soaring costs’ practices are facing.
Professor Banfield added: ‘Yes, we need to slash bureaucracy and allow GPs to focus on health outcomes rather than ticking boxes, but we also need to massively invest in practices and staff.
‘As the Commission notes, continuity of care is key, but practices cannot offer this if GPs keep leaving and practices keep closing.’
Dr Jennifer Dixon, chief executive of the Health Foundation, said the report is ‘right to focus’ on the potential of AI and technology, but that staff will need support to manage any changes.
‘The NHS is not a broken model, and the poor state of the nation’s health is entirely avoidable. The next government should take these recommendations seriously and, crucially, provide the investment that is so desperately needed,’ she added.
Dame Gerada said: ‘What an important report and I’m proud to have been part of the commission. The future health system must invest in technology, data and digitalisation if it to meet the needs of tomorrow’s patients.’
In September, a Nuffield Trust report said the Government must act to fix the ‘leaky’ GP training pipeline and paying for student loans could be a cost-effective way of doing this.
At the end of last year, shadow health secretary Wes Streeting revealed plans to conduct a shake-up of GP services to create new ‘neighbourhood health centres’, if the party wins the next general election.
The Times Commission’s 10-point plan for health
- Create digital health accounts for patients, called patient passports, accessed through the NHS app, to book appointments, order prescriptions, view records, test results or referral letters and contact clinicians.
- Tackle waiting lists by introducing a national programme of weekend high intensity theatre lists to get through a week of planned operations in a day and create seven-day-a-week surgical hubs.
- Reform the GP contract to focus on wider health outcomes, ensure prompt appointments and restore continuity of care. Encourage more super-practices and create community health centres.
- Write off student loans for doctors, nurses and midwives who stay in the NHS. Debt should be cut by 30 per cent for those staying three years, 70 per cent for seven years and 100 per cent for ten.
- Introduce no-blame compensation for medical errors with settlements determined according to need to ensure families get quick support and encourage the NHS to learn from mistakes.
- A National Care System giving the right to appropriate support in a timely fashion. Equal but different from the NHS, it should be administered locally and delivered by a mixture of public and private sectors.
- Guarantee that all children and young people requiring mental health support can get timely treatment and rapid follow up appointments. Publish data on waiting times for all mental health services.
- Tackle obesity by expanding the sugar tax, taxing salt, implementing a pre-watershed ban on junk food advertising and reducing cartoons on packaging to minimise children’s exposure to unhealthy food.
- Incentivise NHS staff to take part in research and put the case for research to their patients by giving 20 per cent of consultants and other senior clinicians 20 per cent protected time for research.
- Establish a Healthy Lives Committee empowered by a legally binding commitment to increase healthy life expectancy by five years in a decade.
Cant help but think its privatise or fail now.
All well and good but non of this is achievable without a workforce to do it ! You can do all the blue sky thinking you want but its not reality. the public need to realise the NHS cannot continue to provide the care it was set up for and is now unaffordable in the current economic climate and with the depleting workforce . No one seems to be listening to this just coming up with ideas to create more work for an already overstretched service.
Cant help but feel super-practices and improving continuity of care are pulling in different directions.
The highest satisfaction and most continuity of care are provided by:
– small practices
– with a dispensary
Just replicate that. Most of all make sure you get Lord Darzi as far away from primary care reform as possible. He’s totally useless.
Who the “F” are “The Times Health Commission” The Times as in The Times newspaper?? Who’s are these people? The same tired old names..”Lord” Dazi ..Getada (runs a super practice). We’ve given up on democracy ij this country. You just need to be a big name and have connections in the media and you can behave like the own the country. WHY is “Lord” Dazi a tertiary liver surgeon dictating primary care policy. WHY is Gerada dictating to the profession? Who owns this country? None of us that is 100% clear.
If this is the best they can come up with, we are really in trouble. They haven’t accurately identified the problems, and who is responsible for them; and their solutions are largely irrelevances.
In our case, the problem with general practice isn’t the model or the management of individual practices – it is the level of funding. This is the elephant in the room, and a deeply inconvenient truth to NHSE.
MDTs, digital triage, ARRS staff, access to records etc etc… none of these improve the service, make it more cost effective or safer, or make it more efficient, and in many cases they make it worse on all counts.
Why do governments and newspapers and think tanks go to the same old names for ideas?
Surely it might be sensible to listen to what our actual leaders (eg from GPC) might suggest, as they actually undertand the problem, and their solutions might be workable?
Increasingly it is looking like the NHS is doomed, and the future of general practice (and holistic care from a family doctor) will be in the private sector, leaving behind an unproductive, inefficient, process-driven, impersonal husk of primary care delivered by people who aren’t doctors or nurses.
Spot on comments above re Dazi.
Not sure who the Times commission are, prob the newspaper but glad they recognise the massive strain obesity is planning on healthcare and that public health measures are key not “population health”.
Needs to go further nad tax processed and super processed food and use that money to fund fresh produce cheaply.
Correct super practices are in opposition to continuity and that small practices with dispensary are ideal model.
Privatisation is no particular solution.
US spend 20% GDP on private healthcare systems with shite care and we spend 10% of GDP.
Cleary NHS is underfunded, primary care is the cheap effective bit; fund it better, increase 8% nhs funding to 12% nhs funding, all into core contract, leave the rest to GPs allowing them to employ the ARSE staff as they feel best and safest. And then govt and NHSE foxtrot oscar.
If we can remove vast swathes of the timewasters that are NHSE managers and nhs trust managers that would help functioning of NHS too.
We don’t need grand strategies, commissions, reports, plans, networks, systems or anything else.
Just fund general practice properly asap and FO.
And can we get independent regulatory system for NHSE managers and NHS trust managers while we are at it. Dodgy bunch.
Letby case, Brighton hospital, Dr Chris Day. Unelected, unaccountable, scurrilous burocrats some of them.
With a revolving door to re employment in overpaid managerial jobs after sequential cock ups
The political wagons are circling wanting more control and to further cap costs Access (and digital) in their minds trump consistency and they think the great British public thinks the same way Super-practices and salaried models with admin managed centrally at PCN level will be pushed hard by both main parties
Apparently the Times spent a year (A YEAR!) to come up with this dross.
They want high intensity weekend operating theatres (where are the surgeons going to come from?) but also give consultants 20% of their time protected to do research???
It totally contradicts itself.
Labour will probably love it.
Super-practices? – easier to package for selling off to the yanks when begging for that trade deal, I suppose….Can’t believe Gerada signed up to this – thought she’d know better. Has this report been funded by 55 Tufton Street?
Tufton street you betcha.
These are the same clowns in a different circus marquee in my opinion.
I saw this report in The Times today and it is another round table of dreamers, many in my view who appear to be very remote from the rest of us in the current real world of General Practice but what did we all expect.
The Times Health Commission-another grand title to add to the failing grand NHS England.
Continually producing strap lines but not looking back at the wasteland of the NHS they are leaving behind in my opinion..
We should all buckle in and get ready for the next 5 years of repeated headlines of how AI will solve all our problems until we finally end of with a Virtual NHS which does not actually exist in reality.
Failed PCNs destroying the NHS and now lets now work on the next nuclear explosion of a plan to demoralise the NHS even further.
Super practices will work in certain circumstances but not as a fix for the NHS and as mentioned already small practices also perform extremely well especially when supported. No doubt many medium sized practices are also excellent.
When will this travelling circus of managers, board hoppers and meddlers flitting from one wrecking ball to another realise a simple one size fits all will not work.
More like a clown car. with bit falling off.
More complexity, more digital solutions, more retraining, more re-organisation. 19 members of the commission, two with a primary care background (Gerada, Mark Porter). One delegate from the King’s Fund – usually a good resource. The Times is owned by Murdoch so will always opine to appease its backers. No mention of retention, recruitment, funding. It’s all organisational churn and managerialism.
If it is true that The Times run this outfit (https://www.thetimes.co.uk/article/the-times-health-commission-recommendations-nhs-dzhvfzbs6), could the author tell us the names of the rest of the Ten who are on the payroll of the non-dom billionaire Murdoch, also known as the “dirty digger”.
Times Health Lobbysquad, more like. Not to be aggrandised by mistaking it for an actual commission or thinktank. Noisy promotion attempting to disable the real Health thinktank reports by King’s Fund, Nuffield Trust, Health Foundation, and Institute for Government, which clearly outline the basics as the tangible causes and remedies. You might think that’d be enough when all the authoritative reports have more or less come to the same conclusions; but no, the Times Lobbysquad prefer the repeatedly rehashed word-speak we’ve all heard many times. There is no new substance apart from less debt, later promise of retention. ‘Prevention’ isn’t prevention – ‘precision technology’ in the real world will reduce productivity: generating more tech inputs than curative outputs, heavily driven by industry. ‘Health outcomes’ are the (undefined) golden coin; but such outcomes predominantly led by socio-economic determinants, so poorer areas will get further defunded (see MPIG).
Darzi proposed Polyclinics back in 2008, then joined with the WEF/McKinsey squad in 2012/13, bringing in private sector and particularly USA – check history and engineering of Centene and Babylon personnel and revolving doors.
Digital Health is predictably proving disastrous due to its design by industry rather than medical systems: have you actually tried the NHS (cr)App, or the digital telephony void, or getting an actual GP appointment, or the 999 algorithms that fail 20% of strokes who then refuse ambulance requests (including mine), or the dangerously inaccurate chatbot algorithms…deteriorating services with inadequate evaluations which are then promoted as improvements?
The Times Lobbysquad is a rehash of ‘solutions’ already long-decided upon, and cannot resolve the problems that actually lie elsewhere.
Centreground and others make some good points.
Surgeons giving advice to GPs seen it all before during
my 30 years in the NHS… the only thing which works are small practices like mine with a dispensary.. I know all my 5000 patients off by heart thats continuity.. it saves time and money and I have some of the best patient feed back you can get…. replicate that up and down the country and bingo patients are happy
Darzi’s just regurgitating what were hailed as his previously “visionary” pronouncements – which of course failed, as they had the previous generations before – but under a different name.
Single passport for everyone, that they carry around, then get pissed and arrive in A/E, unable to remember their NHS app login, err no access their vital medical records. So what do you need, you need a central backup, err……. if you have a central backup do you need the passport?
Regards
Paul C
As ever, only the supply side measures are discussed. Where are the measures to limit demand?
Seemingly not possible within the NHS system. Time for a European or Australian model. Furthermore, so much of demand is driven by social, not medical problems. Let us focus on these therefore thus reducing the numbers of “people requiring mental health support ..[and}.. timely treatment”.
Completely agree that small practices should be the norm, not the exception.
Patients should be able to ‘self refer to dermatology’??
Dermatology is the LAST area that should happen, because GPs have the same equipment as dermatologists: EYES! There are plenty of derm GPwSIs out there. We have 3 (including me) that screen referrals out…….we reduced 2WW referrals by over 40% in 2021 by screening them and the melanoma detection rate went UP.
We don’t have endoscopes and scanners to rule out cancer though.
This ‘report’ is more evidence of London fuckwittery I’m afraid.
Our small surgery would be ripe for supersizing. Our next two small Surgeries are over 30 minutes away by car in good weather, but can be inaccessible for many hours if it rains heavily and road floods. Railway floods too a couple times a year, and stops for 1-2 day.
To cover 20,000 patients (excluding the 6 weeks high summer season), means including practices over an hour away by car; 90 minutes by bus, and £75 to £ 100 by taxi (incl return), but involves even more roads subject to flooding, and a change of trains and buses.
Population of 275,000 eh? That is the population of about a 2 hour driving radius; many of whom are cut off by heavy rain several times a year.
Obviously the vast majority of these people should leave their homes empty and move to London, to join the unemployed.
Gerada involved; unsurprisingly the result mostly nonsense.
Sounds like a self-appointed, self-promoting cabal. I must use “London Fuckwitery” more in polite conversation.