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Simon Stevens’ message to GPs – expand or die

The new Five Year Forward View from NHS England is the first major policy document since its new chief executive took over in April. And it underlines a new style of leadership.

In contrast to most NHS England documents, it is readable and focussed. For a five-year plan, it should have much more detail on how its aims will be achieved. But it is refreshing to see NHS England setting its own mandate (rather than waiting for ministers to impose one).

It is savvy in its timing as well. Telling politicians that the additional money they have promised for the NHS is not enough months before a general election – it says there will be a £8bn gap even after continued ‘efficiency savings’ – will set the tone of the debate over the NHS.

GPs are also front and centre – there is even a GP treating a young child on the cover.

It admits that GPs are under ‘severe strain’ and promises a ‘new deal’ for the profession, with core funding stabilised for the next two years*, more cash released to ‘upgrade primary care infrastructure’ and an urgent focus on attracting GPs to underdoctored areas.

The proverbial devil will be lurking in the detail, but it is certainly a step in the right direction by Mr Stevens. He has clearly listened to the RCGP, GPC and our own Stop Practice Closures campaign.

But the most radical part of the document looks at how GPs will drive a revolution in how care is provided outside hospital.

It envisages practices forming the rather clumsily worded ‘multispeciality community providers’.

Federations or networks of practices will involve consultants, community services and social workers to shift the majority of outpatient care into the community. They will also run community hospitals, admit patients and – in time – perhaps even take over the whole budget for their registered patient list.

Quite how GPs will be given the headroom to take on these expanded roles is unclear. And although the document explicitly states that there will be space for single-handed GPs, it is difficult to believe that they can lead to anything other than an acceleration of the creeping corporatisation of general practice.

And there is a sting in the tail. The document also says that hospitals will be allowed to open their own GP surgeries in areas where ‘general practice is under strain’ for the first time.

It says that there will have to be ‘safeguards’ to ensure that these new hospital-run practices do not just become a ‘feeder’ for expanding secondary care activity. But the implications of this are clear.

Mr Stevens has thrown down the gauntlet to GPs. Expand or watch hospitals gobble you up.

Nigel Praities is editor of Pulse

*Update at 17:09: Although NHS England has confirmed that the current schedule of PMS reviews and MPIG cuts will remain – so not much stability there.