I have always believed that you need to set the agenda rather than follow it - and that is why the BMA’s GP committee (GPC) has published our suggested vision for the future of general practice.
Developing General Practice: Providing Healthcare Solutions for the Future is a consultation document that discusses ideas that look ahead to the long-term future of general practice, while taking into account the immediate pressures GPs are facing. New BMA research published alongside our solutions document provides yet more evidence of the workload and financial challenges that are pushing many GPs and their practices to breaking point.
Grassroots GPs gave a worrying list of examples of how bureaucratic box ticking has left them unable to innovate or get through their clinical work. Many face the real prospect of burnout in the years ahead and there is a clear crisis not only in workload and workforce, but also in morale unfolding across the profession. This has been exacerbated by the unfair scapegoating of GPs by some politicians and elements of the media, and the devaluing of general practice financially through progressive disinvestment (from 10% to 7.47% as a proportion of the total NHS spend in the past decade).
We must reverse this mind-set and highlight not only that general practice is the bedrock that enables the NHS to function daily, but that by valuing its potential with investment it can offer key solutions to the wider pressures in the NHS, as well as its future sustainability.
The GPC calls on the Government for explicit year-on-year increases in resources in general practice as a proportion of the overall NHS budget, which can then translate into more GPs, more staff, more community and frontline services.
New ways to work
General practice is at a crossroads, which requires us to start a debate around the fundamental questions. How do we shape general practice so that it can continue to provide a sustainable, high quality service in an age of rising patient demand and falling NHS resources? What changes do we need to ensure that services adapt to the changing demands of a diverse population with differing requirements of what general practice should deliver? And what are the real issues that should be the Government’s priorities for the future?
With these central themes in mind, our paper seeks to kick-start a debate around suggested solutions - not all necessarily all about GPC policy, as some of the ideas that have been suggested by grassroots GPs to the BMA.
We would like to be clear that we are not suggesting that GPs should be asked to work longer hours, nor backing Government proposals for consumerist extended hours, especially as many GPs are already struggling to cope with spiralling workload, increasing patient demand and falling resources. On the contrary, we want to support GPs to have a manageable and rewarding workload, reclaim professionalism and have time to care for patients, who are the main focus of every GP.
The solutions paper covers a wide range of topics. It includes looking at the benefits of practices working in networks, something that we have repeatedly been asked about by grassroots GPs, ranging from sharing staff, providing a greater range of services, as well as better managing individual workload. And for those practices currently offering voluntary extended hours, or those that may wish to, the ability to do so collaboratively in a less onerous way than the restriction of the current enhanced services DES.
There are bold proposals to build a team around a GP practice through closer working locally between specialist, community and other services, a total rethink of urgent care services based upon integration, and strengthening a patient-centred approach to those with long-term conditions. There are further suggestions around empowering patients to self-care where clinically appropriate which could benefit themselves as well as manage demand on GPs, and further ideas on how we can boost patient participation.
I have no doubt that many of these ideas will spur debate amongst GPs - and this is what we sorely need. It is important that the Government joins the conversation as well. Continuing as we are is not an option for general practice – we must evolve to survive and need fresh ideas alongside the fight for the investment that will make them a reality.
This is part of a new programme where GPC listens to the views of the profession. We want to hear from you about how we can best provide the high quality general practice we wish to deliver to our patients.
Dr Chaand Nagpaul is the chair of the GPC and a GP in Stanmore, Middlesex.
