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2021 Review: Pulse’s vision for general practice

It’s been a tough year for GPs, being demonised by the media, patients and the powers that be. So in September, we decided it was time to turn positive.

We launched our Building a Better General Practice campaign, to provide a forward-looking vision of the profession, devised by GPs themselves.

We canvassed the views of a diverse panel of GPs, at different stages of their careers and varied interests and demographics, asking about the unique skills GPs possess, how they can be best used and in what kind of system.

We also circulated four surveys among readers.

The results painted a clear picture, and from them we created a list of principles to build a better general practice: a manifesto of sorts, to be sent to ministers, health managers, the BMA and the RCGP.

Our vision is split into four elements:

A GP’s role – managing undifferentiated illness; heading up and co-ordinating multidisciplinary teams that would provide protocol-driven care; and providing complex care for undifferentiated illness with timely support from secondary care colleagues.

General practice in the system – GPs retaining clinical aspects of their role with adequate resources; supporting the safe and adequate provision of any service but not necessarily providing it themselves; providing easy access to secondary care advice and local guidelines and pathways; streamlining referrals; but not following up on tests on behalf of secondary care.

Organisation – practices should operate as small businesses to provide autonomy and flexibility rather than to derive profit; premises should be provided by the state, including regularly improved co-located services; funding at a minimum guaranteed level should come from the state; there should be a hybrid payment model; core payments should be uplifted with extra activity-based payment from locally commissioned services; smaller practices should be able to collaborate.

Regulation – this should focus on ensuring general practice provides safe care; CPD should be peer-review assessed and should not be recorded.

The hope, at the outset, was that our campaign would be more than just an academic exercise; that these ideas could become a structure upon which general practice could legitimately be rebuilt. In the new year, we will be reaching out further to health managers and ministers to express our vision.

And central to it all will be a single, overarching tenet: trust in GPs.

It’s not an impossible request, as GPs in Scotland have seen with the introduction of the 2018 GP contract north of the border. Although it hasn’t been perfect, and Covid and other pressures have been a barrier, progress has been made.

If we are to make similar progress in England, health bosses and the Government must listen to GPs. GPs are the foundations of general practice, so your vision should be trusted when rebuilding it, better than ever.


Kevlar Cardie 29 December, 2021 12:33 pm

Pigs fuelled and ready for take off.

Decorum Est 31 December, 2021 9:56 pm

It’s all over.