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Why the GP Forward View remains flawed five years on



This month marks five years since the GP Forward View launched, with many of its aspirations for improving general practice and patient care set to be delivered by now. To its credit, the document was the first time in many years that anyone in power had decided to act on the growing crisis in general practice, but the concept of how they sought to address the problems we faced then, and still face now, is flawed.

General practice was given a set list of means of support for the symptoms of systemic failings within the NHS, but no scope to address the root causes. Bringing GPs and other professionals into a working environment that remains untenable; resilience funding to help cope with an unmanageable workload; and centrally procured tech platforms with no scope to tailor them to local needs.

A lot has been said about the 5,000 more GPs target (latterly the 5,000 more ‘doctors working in general practice’ target), but quibbling over numbers misses the point. It doesn’t matter how many more GPs you train, entice from overseas or persuade to return to practice – they will not stay if the job is burning them out and impacting on their health, personal and family lives. The GPFV attempted to address this, such as with resilience funding, some restrictions on secondary care passing work back to GPs and the releasing time for care programme.

Providing resilience programmes perpetuates the idea that the problem is with GPs not being up to the task, rather than the task being set for them is impossible. It provides a fig leaf to those sat at the top of the NHS and the Government who want to say it is not their decisions and wider NHS environment that are the problem – it is the failings of individual healthcare professionals.

The Standard Contract helps to reduce the shift of work from hospitals to GPs, but the interface issues are much more complex than the shift of tasks from one provider to another. We need to create effective team working at all interfaces, with the ability to prioritise time spent building strong professional relationships, and developing appropriate clinical models of care, between those delivering frontline care. Note: ‘delivering’, not commissioning, regulating or overseeing care.

The PCN DES has provided more staff, but it has not bolstered the flagging core of general practice, as these newly recruit roles are shunted between different practices, trying to deliver on whole new streams of activity and targets included in the DES. Sharing these skilled professionals across PCNs should not be the default for every role; there are some roles for which there is sufficient patient need for the professional to be embedded in one practice, building those all-important long term trusted relationships with patients and colleagues as a valued member of the practice team.

If the NHS’ plan for sustainable general practice is to succeed, be it the current one or a future one, there needs to be a full understanding of the role of general practice, the doctor-patient relationship and the place of practices in local communities. It is not a conveyor belt service of ten-minute appointments badged as ‘access’. So much of what we offer cannot be quantified in numbers and spat out as a report each month. We offer immense value to patients and the wider healthcare system, and this must be recognised.

There needs to be recognition that the time and resource in general practice is finite. General practice needs to be enabled to use this finite capacity in the best way to maximise the value to their patients and local communities, be it through technology, or new pathways and ways of system working. The best solutions for practices and their patients cannot be determined at a central level.

And there must be care of the workforce. Ensuring safe, sustainable workloads needs a whole system approach, prioritisation and accountability for outcomes among NHS leaders.

A resilience course won’t deliver it. Headcounts on spreadsheets won’t deliver it. Another dozen targets met each month won’t deliver it. Only trusting the people providing the service to care for themselves, their colleagues and their patients will deliver meaningful change.

Dr Lisa Harrod-Rothwell is deputy chief executive of Londonwide LMCs and a sessional GP in Essex.

READERS' COMMENTS [4]

John Glasspool 30 April, 2021 6:56 am

Actually, it’s mostly about THE MONEY. You can earn c £100k pa as a lorry driver, with a lot less responsibility and a lot less grief. OK, there are some high-earning rural, dispensing practices, but most aren’t. There is still the paraadox, that has never been addressed, that it’s better paid in the nicer areas. Until that’s addressed, people will not stay in more difficult areas. At least it’s easier to move practice now. DOI None. I WAS an urban GP but escaped and now watch my former colleagues swimming in a cesspit whilst I munch popcorn.

Simon Gilbert 30 April, 2021 12:12 pm

I pointed out via a “Make a Difference Alert” that a “patient journey” where a neurosurgeon sends a letter to the GP to ask the GP to refer to the pain clinic in the same hospital for an injection then re-refer the patient if the injection doesn’t work as this would influence whether surgery was indicated was suboptimal and against the 2016 standard contract.
The trust response included a list of banned internal hospital referrals agreed/mandated by commissioners in 2017 that included the pain clinic.

A physiotherapy pathway commissioned since then still leads to shoulder surgeons waiting till outpatient clinic to ask the GP to refer to physio, as they can’t refer directly, with consequent delays in referral, wasted time and possibility of worse outcomes.

If commissioners are actively ignorant of GPFV and national contractual guidance, and don’t resolve these issues, no amount of BMA template writing will work and the GP workload and patient risk from excess transfers of care remains much higher than it could be.

James Weems 3 May, 2021 11:10 pm

I wrote over 100 template letters. The work kept on coming.
I don’t waste my time now. I just say no, ask the hospital to do it and usually email it copy the patient back in advising their hospital doctor will be in touch. The ease of access into GP works both ways!