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GPs ‘least involved’ in sweeping plans for NHS change, warns King’s Fund



GPs are among the least involved in drawing up sweeping changes being planned for NHS services across England, a think-tank has warned.

In its report on the development of the sustainability and transformation plans (STPs), the King’s Fund said that across the four areas they studied, ‘those least involved in the process from within the NHS were GPs and primary care services’.

The report said their lack of involvement was because STP leaders found it ‘difficult’ to engage with GPs, ‘given the large number of GPs in each area and the differences in views between them’.

The report comes after Pulse warned in August that GP leaders said they are being ‘excluded’ from discussions over the vital new plans.

In the four areas, which the report has kept anonymous, some used CCGs as a ‘proxy for GP involvement’, despite most CCG leaders saying they were involved in STP discussions as commissioners. 

Where the STPs did engage with GP federations, the report describes their involvement as ‘emergent forms of collaboration’ and only two areas were found to be engaging with GPs through the LMC.

Hugh Alderwick, a senior policy adviser at the King’s Fund, said: ‘Gaining meaningful involvement in the plans from anybody was difficult within the time available. So within the NHS the groups least involved were GPs, clinicians, and frontline staff.’ 

In the report, one anonymous interviewee said the STPs were not ‘talking enough about primary care’ and instead focusing on acute service reconfiguration, including the closure of some hospitals.

The report also criticised NHS England’s efforts to keep the plans secret.

The King’s Fund found national NHS bodies has asked STP leaders ‘to keep details of draft STPs out of the public domain’.

It said: ‘This included instructions to actively reject Freedom of Information Act requests (FOIs) to see draft plans.’

It said ‘two main reasons were given for this’. The first was ‘that national NHS leaders wanted to be able to ‘manage’ the STP narrative at a national level – particularly where plans might involve politically sensitive changes to hospital services’.

The second was that ‘national leaders did not want draft proposals to be made public until they had agreed on their content’.

The King’s Fund added that ‘local leaders were typically unsupportive of this approach’.

Despite this, King’s Fund chief executive Chris Ham said: ‘The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them.

‘For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population.’

He added that the NHS was under ‘unprecedented pressure’ and that ‘if STPs do not work then there is no plan B’.

BMA chair Dr Mark Porter said: ‘Doctors are becoming increasingly concerned that the primary focus of NHS transformation is not on delivering the best possible patient care, but in cutting back budgets and, therefore, services.

‘Above all, the Government must not use these transformation plans as a cover for further starving services of resource and patients of care.’