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Extending GP access forms part of major NHS consultation on future of general practice



GPs face providing more appointments in the evening and at weekends, under NHS England suggestions on how to address ‘growing dissatisfaction’ with access to practices put out for consultation today.

The major public consultation on the future of general practice asks for suggestions on how to stimulate ‘more convenient routine access to GP services’ and improve ‘the speed of contact for urgent problems’.

It also asks for opinions on how to ‘strengthen accountability’ for the quality of out-of-hours care and on how to take forward health secretary Jeremy Hunt’s plans for a ‘named GP’ for patients with complex needs.

The consultation calls for ideas on how general practice can operate at ‘greater scale’, while protecting continuity of care, with stronger incentives for inter-practice collaboration and other providers in primary, secondary and social care included in the GP contract.

GP leaders have cautiously welcomed the plans, but warned that any rise in workload will require increased funding for general practice.

The document marks the first details on a ‘fundamental review’ of how practices are paid first revealed by Pulse in May.

The governing body for the NHS says that the consultation will explore ideas to make GPs play an ‘even stronger role at the heart of more integrated out-of-hospital services’ and deliver better health outcomes and more personalised care.

NHS England says that though a recent engagement with GPs, CCGs and other partners it has identified a number of areas that mean GPs face ‘increasingly unsustainable pressures’ and need reform.

These include the impact of an ageing population, growing co-morbidities and increasing patient expectations and increasing pressure on NHS financial resources, which will intensify further from 2015/16.

It also cites ‘growing dissatisfaction with access to services’ and a two-fold variation in GPs and nurses per head of population between more and less deprived areas.

The call comes after a report, drawn up jointly by the Nuffield Trust and King’s Fund think tanks, suggested that NHS England introduces a brand new contract ‘in parallel to the GMS contract’ to incentivise GPs to form networks or larger groups to provide services to improve mental health, elderly care and social care.

The consultation says: ‘The main purpose is to stimulate debate in local communities, among GP practices, CCGs, area teams, health and wellbeing boards and other community partners, on the best way to develop general practice services. 

‘NHS England is also inviting comments about how it can best support local changes, for example through the way national contractual frameworks are developed.’

It asks a number of questions in order to address the problems with general practice, including facilitating better access to GPs.

The document asks: ‘How do we stimulate more convenient routine access to general practice services, including ease of making appointments, speed of contact for urgent problems (whether telephone or face-to-face), ability to book less urgent appointments in advance, ability to communicate electronically (e.g. online consultations) and, particularly for working-age adults, availability of evening/weekend slots?’

It also asks for ideas on how to free up time and resources in general practice, promising to ‘root out bureaucracy and promote more productive practice’ and how to reform QOF to preserve its essential features but reducing the ‘tick-boxes’.

Pulse revealed in May that NHS England were considering radical proposals to scale back the size of the QOF to free up resources for more ‘creative’ ways of incentivising GPs to improve patient care.

The RCGP has welcomed the consultation, saying it was ‘much-needed’.

RCGP chair, Professor Clare Gerada, said: ‘It is very encouraging to see that the strengths of general practice and its position at the centre of the NHS are so readily acknowledged and that GPs, other clinicians and patients in their communities will have such a strong influence in the engagement process and the results it produces.

‘The College’s own 10-year vision for the future of primary care, The 2022 GP, already sets out many of the solutions we need to support and strengthen general practice for the future.

‘We hope that NHS England will help us turn our aspirations for patient care into a reality and that we can work together to bring about major investment in general practice – including 10,000 more doctors –  so that GPs can do even more for their patients in their communities.’

Dr Richard Vautrey, GPC deputy chair, said the document contained ‘a number of positive starting points’ that the BMA would be happy to discuss.

He added: ‘GPs, like all doctors, care deeply about the services they deliver to their patients and will continue to work hard to make improvements. In order to do this, we need to take a holistic approach that recognises all the pressures facing the NHS.

‘We need to recognise that rising workload will require increased funding for general practice as well as a commitment from the government to empower GPs, patients and other healthcare professionals to use their experience to help shape services in the future.’