All new GPs should be offered salaried employment as ‘primary care consultants’, suggests a new think tank report.
GP practices should also operate as ‘spokes’ to a central ‘neighbourhood health hub’, according to the Institute for Public Policy Research (IPPR).
Its new report proposes a 10-point plan reforming health and care services in order to shift towards prevention and productivity.
Currently, services are ‘failing’ to make the country healthier and more prosperous, and on the current trajectory, the UK will increasingly ‘spend more to get less’, according to the think tank.
The authors argued that reforming primary and community care should be at the centre of any shift towards a preventative service, away from a ‘treatment’ service.
However, while primary care was once considered the ‘jewel in the crown’ of the NHS, the report said it has now ‘become a focal point for public dissatisfaction’.
The action plan recognised the need to balance continuity of GP care, which is associated with lower mortality rates, with the ability to scale up primary care so that various community services can be integrated.
It said: ‘We propose an evolution in the PCN model. We recommend the “network” model is developed into a “hub and spoke” model, with a central Neighbourhood Health Hub created at the centre of every PCN.’
The proposed hubs would join up services such as mental healthcare and outpatient diagnostics, as well as take responsibility from GP practices for population health management and enhanced service provision, while practices, as spokes, can continue to focus on delivering continuity to patients.
However, the report said that GP partners’ time would still remain ‘constrained’ by the administration and stress of running a partnership.
As such, another action in the 10-point plan urged the Government to ensure all newly qualified GPs have a right to salaried employment, with pay in line with hospital consultants.
According to the authors, this should also be offered to GP partners over time, with ICSs offering to purchase any GP practice where partners take it up. However, they emphasised that ‘no partner should be forced to take up these salaried roles’.
This would make a general practice career more ‘attractive’ and ‘sustainable’ by cutting bureaucracy and enabling portfolio roles with more variety.
The report said: ‘The alternative is to allow the partnership model to decline at pace. This would risk heaping a significant administrative burden on an increasingly small number of overworked, partner GPs.
‘Worse, it could lead to partner GPs struggling to get out of their contracts and practices at retirement. This is not a viable vision for an area of healthcare as integral to the future as primary care.’
The think tank has put forward earlier versions of these proposals before the pandemic, and in June, Lord Ara Darzi, chair of the IPPR’s Commission on Health and Prosperity, argued that GP services should be brought ‘into the fold’.
More widely, the report lays out the case for reforming healthcare, drawing on modelling showing that 240,000 fewer people would have died in the decade from 2010 if the UK had an avoidable mortality rate similar to those in comparable European countries.
The IPPR claimed that its reform proposals ‘could save taxpayers up to £205bn over the next decade by freeing up growing sums each year’.
Other recommendations in the report include striking a new deal with health and care workers which focuses on ‘better take-home pay’ and ‘stronger worker rights’, as well as upgrades to digital and physical infrastructure.
Earlier this year, doctors at the BMA’s Annual Representative Meeting (ARM) voted in favour of GP practices withdrawing from PCNs next year.
However, Pulse exclusively revealed last month that NHS England has no plans to scrap PCNs.
In June, GP leaders at the BMA wrote to the Labour Party in a bid to change its position on the future of the partnership model.
There had been some confusion over Labour’s position on the GP partnership model earlier this year – with shadow health secretary Wes Streeting offering conflicting opinions.
However party leader Sir Keir Starmer made the position clear in May when he said the GP partnership model is ‘coming to an end of its life’ and that the NHS needs ‘more salaried GPs’.
Salaried service really working well with consultants and junior doctors at he moment eh!
I’ve just read the report and the lack of understanding of the current ground truth is palpable. It’s proper moon on a stick stuff.
Sounds like a great idea if there were enough GPs.
We are currently 10000FTE – so 15000 headcount short of what we need with the current model.
And moving 25000 GP partners towards a salaried role would require another 15000 GPs.
So when you have 30000 more GPs available, come back and we’ll think more carefully about this idea.
“the centre of any shift towards a preventative service, away from a ‘treatment’ service.” ..so the aim is to stop treating people and prevent illness instead? Great. Nice one. Very clever. That will save a fortune. The calculations are clear. Genius. Hang on, just a quick query about that, what happens when the guy who didn’t die of an MI (because it was prevented) gets a little older and might come back with cancer – i guess we’re going to ‘prevent that’. Thats what all those fitt tests are for. Ok. He gets a little older and might get dementia..oh but we prevent that..cool now he’s 108, he has grown himself a massive prostate, can hardly pass urine and it risk of a life threatening uti induced sepsis, what do we do then? Oh I see, prevent that. Silly me, yes obviously , that one was ‘prevented’ already he had a TURP. Silly me. So now he’s 116 blind as a bat and falling over every time he gets up to have a poo. What do we do about those pressure sores on his bum exacerbated by sitting all day wearing incontinence pads. And what about all the cuts on his legs, those pesky leg ulcers because they aren’t healing because, well because he’s 100 and feckin 16 years old. District nurses to prevent the pressure sores, OT to prevent the falls , i hear you shout. Oh I see now i get it, now it makes sense, this guy ain’t never going to die ..we dont need treatment in primary care??!. Just prevention. It will indeed save the country a fortune. NOT.
It looks like the hubs have no idea what continuity is either!
Why would one make all the brand new inexperienced GPs into Consultants, rather than the existing very experienced GPs we already have? Seems like an upside-down heirarchy, where experienced GPs (providing continuity, but no preventive services, somehow??) will have to refer patients to GP consultants who know less (by definition) about what to do – ah but maybe that is the point, they will only be expected to refer them back with a ticking off to the experienced GP for failing to Prevent the illness.
@A Non
Yes. Preventative treatment is fine: it improves both length and quality of life. But it doesn’t reduce overall health costs in the long run. See for instance https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html
Preventative care cheaper. LMAO. It’s what is bankrupting the NHS already, especially while trying to close the gaps at the same time.
Sounds great, can I get a full time salary but only see 8 patients per session for 1-3 sessions a week, like the consultants at the nearby centre of excellence? Maybe squeeze in a weekly virtual ward round walking around a few virtual beds?
@A Non
Genius post. I have been arguing for years prevention does not save money. Just increases elderly population who cost the most to NHS.
Good thing to do, but does not save money.
I note there that GPs have failed to provide “prosperity” too. Didn’t know that was in the contract!
Hmm, I am sure I have heard Lord Darzi’s name before. I think he has proposed something very similar in the past too which obviously did not work. I hope it will work this time, as they say: if at first you do not succeed, try try try again. I also amazed by the fact that the report suggest we are getting less for more at present, and need to shift to this model which will save us more money and make GPs like the hospital doctors. This could have been a Monty Python sketch, only if it was not true.
You can call a turd what you want, it will remain a turd. Unless there is higher pay and better working conditions, this whole plan remains a wast of time and space.
I believe that this is a return to Bevan’s thinking – it is my belief that he felt that good NHS care & preventative care would reduce the demands on the NHS in the longer term. So all these years later we are hearing the same suggestions. Surely if that outcome was going to become a reality we would have seen it by now? People still have to die & get ill before they do so, just at an older age than before.
Prevention does not work in a society that wants to do what it wants – it might do so in an authoritarian state that enforced behaviours on the population but encouraging major changes in lifestyle & actions in a democratic state will only happen at a very slow pace – how long has it taken us to effect change in smoking behaviour for example?
These are the plans of desperate people who have no reasonable solution to put forward & so come up with “radical alternatives”. I applaud Bevan for his hopes but they were not realised & only a fool expects a different outcome now.
This is rhetoric that is bound to fail in my view
The authors argued that reforming primary and community care should be at the centre of any shift towards a preventative service, away from a ‘treatment’ service.
you don’t need a “preventative service”
it’s on every packet of fags for a start !!
That’s me off then
‘Primary Care consultant’ is such a naff name, which won’t mean anything at all to the general public…let’s just stick to GP please
Instead of focussing on GP partners how about the same principal is applied to pharmacies first. The pharmacy model is much simpler . Why doesn’t the nhs employ its own pharmacists instead of contracting to a shop whose only customer is the nhs. I certainly know of pharmacists who are now multimillionaires based on this archaic closed protected system. The average small run down pharmacy shop sells for eye watering sums. That’s ultimately taxpayers money..
We’ve seen this before. Renaming and rebranding a failing service. The bottom line is : Where’s the funding and the staffing????