GPs are willing to consider ‘radical’ changes to their model of practise because they have been ‘systematically under-invested in’, NHS England’s chief executive has said.
Simon Stevens said that general practice in England will change, away from the ‘cottage industry’, with new models including hospital takeovers and GP super-practices.
And he said these changes were made possible because GPs were ‘willing to contemplate some quite radical changes’, but he admitted that this was a direct response to under-investment and NHS leaders placing ‘rising workload and demands’ on GPs.
Asked by the House of Lords NHS sustainability committee whether it was time for hospital trust to take over the running of general practice, Mr Stevens said: ‘In a nutshell, I would say general practice is a flotilla, not an aircraft carrier and so it will develop in different ways in different parts of the country.’
He added that ‘we are going to see a mixed model in the way in which primary care develops’ across the country, depending on issues such as local leadership.
And, seemingly admitting that GPs had been given little choice in the matter, Mr Stevens said: ‘My reading is that GPs are not crying wolf. Actually they have been systematically under-supported and under-invested in, relative to the rising workloads and demands that we are placing on them.
‘And that because, frankly, their backs are against the wall, they are now willing to contemplate some quite radical changes to the way in which general practice operates.’
But he said the new models would be ‘maintaining the best features of it, including list-based continuity of care for populations and the personal relationship for those patients that want it’.
And he argued that the wider range of changes NHS England is pushing through within the health service at the moment did not amount to another ‘top-down reorganisation’ – something the Government had promised the electorate that it would not do.
Mr Stevens said: ‘Rather than a new Big Bang top-down reorganisation, which I think would have most people in the health service jumping off a cliff, we are trying to do this organically.’
His comments come as Pulse recently uncovered an internal NHS England memo which said vulnerable GP practices must ‘transform…or be allowed to fail and wither’ although at the time NHS England denied that this was their national policy.
Partners jumping ship
As a Pulse analysis outlined in July, NHS England’s Five Year Forward View is quietly driving a move among practices to hand back their contracts, with GPs willing to work in salaried roles for foundation trusts, GP federations or under the ‘new models of care’.
And in Scotland and Wales, health boards are increasingly taking over contracts – and practice staff – when retiring partners cannot be replaced.
A Pulse survey revealed over half of partners would consider going salaried – a massive shift from just a few years ago.
Decreased funding, increased demand, the advent of CQC inspections and widespread problems with GP recruitment, among many other reasons, have significantly reduced the appeal of the traditional partnership model of general practice.
A BMA survey of 5,000 GPs has – as we report – shown that the support for the independent contractor model remains the most favoured option, although the fact that a third of respondents favoured other options would have been unthinkable not too long ago.
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