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Dr Chaand Nagpaul: ‘We want practices to retain benefits of smallness while getting bigger’

A range of things need to happen, and they need to happen very quickly, to ensure general practice can continue as a discipline at a time when all the evidence around us shows that it is at serious risk of not being sustainable. Because of the recruitment and retention problems, widespread burnout and with demand outstripping supply.

One is workload management, which has to be tackled straight away – by reducing workload and also demand. We need a government backed national promotion of appropriate use of GP services, ending inappropriate workload shift, and empowering patients to self-care and manage.

Another is for GP practices to work together so that they can share staff and management, cross cover as well as employ teams of professional support – such as nurses or pharmacists – in a way that could be very difficult for individual practices to achieve.

We do not want large impersonal structures – our research among GPs and patients show both value continuity of care. This is not the ending of small practices, it is about working in collaborative structures- it is really about retaining the benefit of smallness whilst getting bigger.

We believe this can take many different forms, including in some instances larger practices federating and in other instances the formation of super practices. We should not be prescriptive about any one model and neither should we be saying, and this is crucial to understand, that all small practices don’t have a future.

At time when there aren’t enough GPs, we do need practices to be supported by other healthcare staff but this extension has to be funded. Rather than these pockets of funding via pilot arrangements – as in the current example where a handful of practices will receive funding to hire a pharmacist – we want mainstream funding to enable GPs to employ a skill mix of support. And we need integrated nursing teams supporting practices to look after increasing older patients in the community

We also need to address the issue of premises. The Government’s infrastructure fund is nowhere near enough to really provide the scale of the expansion of general practice that is necessary. We would like to see secure, sustained funding for estate development – including for example funding primary care hubs for diagnostics and community services for use by multiple practices.

At the moment what we have got is GP practices isolated and incurring a disproportionate level of work, much of it inappropriate and with the buck stopping with GP when in fact there are other parts of the system that should be addressing the needs of patients first.

Lastly, we need a range of opportunities for GP career progression via working arrangements including partnership and employed positions, and these can be provided within GP practice networks.

This is not a magic bullet but a framework made up of multiple facets which will cost money. The Government has made promises of investment in general practice. What we are saying is that politicians must be held to account and to deliver that investment so that general practice across the country is given proper funding and support to have a sustainable future. A failure to do so would be a dereliction of its duty to look after the nation’s health.

Dr Chaand Nagpaul is chair of the GPC and a GP in northwest London

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