GPs deserve urgent clarity on what neighbourhood health really means

Editor Sofia Lind on how GPs are being asked to risk everything to sign up to ‘neighbourhood health’ without being given any detail on what that might really mean

When GP leaders came together on Monday for a conference to discuss the 10-year health plan, there was a painful lack of clarity on what ‘neighbourhood health’ entails in practice for GPs.

It was also obvious that this vacuum is leaving GP partners in an uncertain and precarious position with very real personal consequences.

Questions that kept coming up were naturally centred around contractual risk and liability, premises ownership and leadership. But there were also deep concerns about the unintended consequences for patients.

As it stands, we do not know who will lead neighbourhood teams and GPs are understandably concerned at the perceived sway towards hospital trusts, as existing local health organisations with large footprints.

There is also little known about the future of premises. While the Government has now clarified that around four in 10 neighbourhood health centres to open by 2030 will be created by refurbishing existing buildings in the NHS estate, it has not said what will happen to existing GP practice premises or their ownership.

Speaking at Monday’s virtual conference, hosted by the Westminster Health Forum, BMA’s GP Committee chair Dr Katie Bramall also reiterated her understanding that local enhanced services will be hoovered up into neighbourhood health and the two new GP contracts that were announced in the 10-year plan.

Another concern highlighted by both Dr Bramall and RCGP chair Dr Victoria Tzortziou Brown during the meeting was what impact neighbourhood working will have on the existing PCN footprints which GPs have spent the last six years implementing. The GPC chair even expressed concerns that outlier PCNs could come under the threat of breach notices if they could not align with the new neighbourhoods.

Both GP leaders also noted the problems with workforce. Although the number of GPs coming out of training has increased, there are problems with finding substantive employment due to practice underfunding, and notably the long-term workforce plan does not yet incorporate any retention strategy for senior GPs.

Serious concerns were also raised about the reforms being pushed through without funding attached. But a large part of the conversation was focused around the fear of the loss of continuity of care, and the relationship between GPs and their patients. Dr Bramall went as far as to say that without continuity, there is ‘no joy’ in the job anymore. And she fears there’s a whole ‘generation’ of new GPs who have not experienced this type of practice.

Examples raised included the recent online access contractual obligation – which was a ‘red line’ for the Government, but which practices have reported takes GP time away from face-to-face contact with their patients.

What with the BMA being in dispute with the Government over online access and the 10-year plan, the Government repeatedly appears to portray the profession as being obstructive in the face of inevitable change. 

This was most recently illustrated a speech yesterday, where health secretary Wes Streeting made the throwaway comment: ‘When the BMA opposed online booking for appointments, I didn’t back down because I knew it was what the public expected and deserved.’

But if he were in the shoes of GP partners, whose livelihoods and personal financial situations are tied up with the GP contract and premises obligations – and there was a vague plan for a complete reorganisation but little detail on what it will look like in practice – I would venture to guess he would also feel unsettled and a tad reluctant.

As it stands, GPs are being asked to risk everything to sign up to a fundamental overhaul, without the required detail. And whilst the invitation of leadership involvement is there in theory, this unknown effectively still sidelines GPs.

GPs now deserve urgent clarity on what neighbourhood health really means.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn