When the General Practice Forward View (GPFV) was launched in April 2016, against the back drop of a decade of underinvestment in general practice, record low GP morale and an already unfolding recruitment crisis, our task was clear. This was to both support and transform the service, as even back then, almost nobody felt what was happening was sustainable. That is even clearer now.
However, in a period of austerity simply increasing general practice funding, in its existing form, was never on offer. What was on offer was more funding for a service, so it could start to rebuild, but also transform in a way that both fulfilled its potential and contributed to the wider sustainability of our NHS.
Frankly, we would not have secured the quantum of funding we did, culminating in an extra £2.4 billion a year for general practice services by 2020/21, had we not adopted this more transformative approach. I am pleased to report the funding trajectory for the GPFV remains on track, despite the many pressures on our NHS.
Twenty-four months in to this five-year programme, which some have described as ‘the biggest change management programme in the history of English general practice’, we are now beginning to see some of the fruits of this investment, and whilst I understand that not every practice is seeing the benefit of every one of the comprehensive package of initiatives yet, we remain clear that all practices should feel the benefit of all its elements by the end of the programme. I recognise this requires the profession to suspend its cynicism, but to give an example, it’s not long ago that if I’d have suggested to a room full of GPs that a state backed indemnity scheme was around the corner, I would have been met with disbelief.
As a working GP, I am also acutely aware of the challenges we still face
The face of general practice is gradually changing. In the last two years, examples include 800 estate and IT schemes completed, 2,100 practices benefiting from the resilience programme, 176 CCGs engaged in the Time for Care programme, over 5,000 trained care navigators, 2,100 trained staff in managing clinical correspondence, numerous digital schemes such as rolling out online consulting and Wi-Fi in practices, and more clinicians servicing 111 calls. There are over 3,900 more FTE other health professionals in practices than two years ago, including around 500 more FTE practice based clinical pharmacists, with over 580 more to follow soon.
Later this year we will also see the full roll out of access hubs to every part of the country, providing much needed appointment capacity for hard pressed practices. We will also start to position the general practice forward view initiatives, and other support, in a way that aligns with, and accelerates, the grassroots move towards working at scale, in the form of primary care networks. I hope this will help bring to life the impact of the GPFV initiatives in your neighbourhood, as I believe they represent a real opportunity to help build resilience within groups of practices, and broaden the range of professionals and services that will work within and alongside practices to help manage demand, as well as offer our patients an enriched version of primary care.
As we move through the gears of the GPFV we need to stay firmly fixed on our aim of improving patient experience, quality of care, sustainability of services, and crucially, developing ways to ensure a more fulfilling working day for all of us. As a working GP, I am also acutely aware of the challenges we still face. We are yet to see our workload significantly reduced by changes to the contract between CCGs and hospitals. And despite having more GPs in training than ever before, reinvigorating the induction and refresher and retention schemes, offering increased flexibility through GP Career Plus schemes and kicking off a major international recruitment campaign, GP recruitment and retention remains a significant problem for most practices. We all know there is much more to do before it starts to feel different. But I also remain convinced of two things. Firstly, we are fixing many of the fundamental issues facing our service, such as indemnity, and there are a steadily growing number of practices, that have actively engaged with the programme, that are starting to see the benefits.
Dr Arvind Madan is director of primary care and deputy medical director for NHS England