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Trust the process?

Short-term boost

Waking up on a Saturday morning to the Times headline that general practice is set to be ‘nationalised’ is not my ideal way to start the weekend. It was pretty much the only thing on my timeline (other than football transfers, of course). And the message seemed to be: ‘That’s me finished with general practice.’

The review of general practice – as usual, announced in the national media first – was a shock to me. Also as usual, there was nothing substantive there. The letter from the health secretary to the Prime Minister trotted out the old tropes about there being ‘considerable drawbacks’ to the current contractor system including an ‘underinvestment in prevention’. The review, it said, will look at ‘workforce, business models and how GPs work with the other parts of the NHS such as hospitals’ with a view to ‘bringing together primary and secondary care’.

We’ve heard this plenty of times before: their ‘vanguards’ ultimately led to PCNs, after all. But there was an interesting aspect to the potential plans. Sajid Javid referred to what was happening in Wolverhampton and Gosport, where trusts have taken over GP practices.

I suspect that this report – which deliberately found its way to the Times – is testing out whether this could be rolled out further. And, as it stands, I think there might be merit to giving practices the option to join trusts.

I absolutely know the arguments against it. The beauty of general practice is its flexibility – I remember former RCGP chair Professor Helen Stokes-Lampard once saying that she is proud she doesn’t need to contact the facilities department if she wants to change a lightbulb. Furthermore, the danger that GPs will be asked to pop in to A&E to help out will be ever present. And I get that there is the worry that general practice will be the forgotten toy in the corner.

But I also get that general practice is unsustainable as it is. If GPs were to have the choice to clock in with their employers, deal with patients, leave on time, and have the trust having to sort out questions around access, CQC inspections and hitting targets, then that could benefit GPs. Though, of course, it goes without saying that no practice should be forced to be taken over by a trust.

Personally, I think the best solution for patient care by a long way is sustained investment and support in the partnership model. In terms of patient care, I am not even sure whether this latest suggestion is better than the current flawed, underinvested partnership model. But that will be a question for the trusts and, more than currently at least, the Government.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at


Patrufini Duffy 2 February, 2022 4:03 pm

I warned you eons ago. You opt into a PCN, they take over your IT systems, they actually increase the monitoring of your datasets and shame you, they see your free slots and they fill them with exclamation marks from a central coordinator. They remove the need for your reception teams, any “individual or personalised” meaning, and they dictate your opening times, your lunch break, your re-directs and your life. Sheep herded. You can clock in and clock out, but you’ll still see 40 a day in corporate land, people from miles away, another member practice list perhaps. A model by the Americans and business savvy GPs who want to connect a bit of Operose, with a bit of HCA, and take the windfall. Portfolio GPs. I’m not against it, just observing. All via an investment banker called Sajid. But, you have a named list, continuity – we gotta keep blurting out that sour word. Like a sheep. Or donkey. You played into their hands during a pandemic. Keep opting in, bending your spine, and soon you’ll be opting out. Which might be the plan. At least a hospital run GP site can’t reject a referral, or maybe they can. Maybe that’s the plan?

Malcolm Ridgway 2 February, 2022 9:49 pm

GPs and community services could form large cooperatives in a similar we did in the 90’s for OOHs care. At least there would be a greater degree of control, it would be run by those that understand how to do primary care, yet there would be the benefits of operating in a big organisation You can still have your personal list and even your own mini-team like they do in Kaiser. Just waiting for something to happen will have inevitable consequences.

Angus Murray-Brown 4 February, 2022 3:42 pm

‘But I also get that general practice is unsustainable as it is.’

It’s not though. Away from the catastrophising on here and on social media there are 1000’s of practices that are ticking along just fine. We just want to be left alone to concentrate on our work.