Editor Jaimie Kaffash argues that NHS England’s vision of an upscaled general practice will have major implications for individual practices’ autonomy
It feels like NHS England has been trying to kill off the GP practice in private for a while now. As a reporter in 2016, I wrote a piece on an NHS England local medical director saying small vulnerable practices should be allowed to ‘wither and fail’. In 2018, former primary care medical director Arvind Madan made his infamous comments that GPs should be ‘pleased’ when small practices close.
However, it seems as though such pronouncements are becoming more public. Dr Madan’s latest successor, Dr Amanda Doyle, has seemingly gone further, and in a public forum at a House of Lords Committee hearing this week. She said: ‘One of the challenges that the current predominant ownership model in general practice gives us is that both investment and revenue flows support that model [of] an individual, practice-sized building.’ This does not ‘sit comfortably’ with NHS England’s plan for ‘scaled up’ primary care that is based on the Dr Claire Fuller ‘neighbourhood model’ that will see local health centres integrating general practice and a number of other services.
While the conversation veered towards premises and estates, the implications of Dr Doyle’s statement cannot be overemphasised. It is NHS England’s stated plan to follow the Fuller model, and this is in keeping with the integration plans that resulted in PCNs. We also know that the NHS has been trying to funnel more money through networks at the expense of practices.
But Dr Doyle’s comments present a step up in my mind. Because the idea that the current funding model is incompatible has major implications for the autonomy of GP practices – and potentially the partnership model.
Even within PCNs – and the push for more funding to be funnelled through them – the guaranteed income of the global sum ensures practices retain their autonomy and individual identities. By casting doubt on the current funding model, Dr Doyle may well be laying the groundwork to remove this funding and, with it, practices’ autonomy.
I’m all for radical ideas, and when Dr Doyle later said that younger GPs are less keen to take a partnership, including building ownership, I had to agree with her. As I have argued before, this isn’t an issue with general practice, it is a societal shift that younger people are understandably less willing to stay in the same role their whole lives. We need a way of addressing this. Separately, I think it is a good idea to review how the global sum works.
But this cannot involve removing autonomy from individual practices – this is a red line for me. Continuity of care may be diminishing, but we can’t just give it up altogether – and that is what NHS England’s vision of upscaled general practice will do (even if they deny it). And crucially, it will take the responsibility of designing general practice away from GPs.
As I argued last week, I can’t imagine that we will see much change in the 2024 GP contract due to the political landscape. But a new, revamped general practice is on its way at some point soon. NHS England have shown their hand – it is up to the profession to retain the autonomy of practices.