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The glaring holes in NHS England’s proposals for general practice



First revealed at Pulse Live, and finally published today by NHS England, there is a lot to digest in its public consultation on the future of general practice.

The document is very wide-ranging and is the first indication about how the new NHS governing body aims to reform primary care.

It raises a myriad of questions for public discussion that could involve a lot more work for GPs, for instance whether to provide more appointments at weekends and evenings, introducing a ‘named GP’ for patients with complex needs and getting the ‘best value’ from enhanced services.

But it contains some ideas that GPs will welcome, such as shifting resources from secondary care into the community, incentivising good care for patients with complex needs and making QOF less ‘tick-boxy’ – as first revealed in Pulse in May.

Incentives to help practices work together more effectively, and with other parts of the health service, are also likely to be welcomed as a counter to the fragmentation seen following the Health and Social Care Act.

But the most interesting thing – as Dr Nigel Dickson points out – is what the document misses out. There is little mention about practices in deprived areas – except for targeting ‘new entry’ in those areas (read ‘private providers’) – or revamping GP premises.

It also does not address the myriad of regulatory paper-shifting from CQC, revalidation etc. – surely one of the biggest GP time-sinks at the moment. It fails to properly address problems of GP retention and burnout – surely this must be a priority if NHS England wants a motivated and capable GP workforce.

But the cautious welcome from the BMA and the RCGP is telling. They welcome a discussion about addressing the pressures on general practice, as they know it is an argument they can win.

Nigel Praities is the deputy editor of Pulse magazine.