General practice is facing some of the toughest challenges in my experience of almost 30 years as a GP. The workload is rising, more people have complex medical problems, community services are often fragmented and resources have not followed the patient but have been used to support the growing dependency on hospital-based care. It is therefore no wonder that we are experiencing the worst recruitment and retention problem in general practice for a generation. But there are still glimmers of hope.
In early October, the Prime Minister announced a new voluntary contract for GPs saying ‘millions of patients will benefit from ground-breaking plans for seven-day access to both their GPs and hospitals.’ It has generated much controversy, largely from a belief that seven-day access would mean seven-day working for all practices, but this new plan could in fact be a great opportunity for us.
Nothing is without risk, but this new contract offers us the opportunity for greater flexibility and less micromanagement
The facts are: by April 2017 there will be a new voluntary contract for practices, groups of practices or GP federations. They will be based on a natural community of 30,000 or more and will involve integration with community nursing and other healthcare professionals. There will be additional funding available for this initiative. Box-ticking will be removed and QOF will be scrapped with the funding going into the baseline practice contracts – while we will still have to record work, we should look at the correct groups only, cholesterol is much more important in a 59-year-old than a 90-year-old.
The most controversial aspect of the contract, and one of the biggest challenges with an overstretched workforce, is adding extra capacity on a Saturday and Sunday. But this proposal is asking for a seven-day service based on a locality, it is not asking for individual GPs or practices to offer a seven-day service. It may be that no practice needs to open – it could be delivered by a provider company linked to general practice. This cannot be delivered without the promised additional funding and in my view must include access to the primary care record.
The contract gives us many opportunities and potential benefits: reduced bureaucracy and tick boxes, additional resources, sustainable general practice, reduced organisational barriers and tribalism, creation of a team based around the patient, led by and supporting the GP, and creation of a common health record with the benefits of reduced duplication, safer provision of care and better team working.
The new contract will be suitable for practices of all sizes but only if the focus in on a natural population and practices are prepared to integrate and work seamlessly with other services. In many areas practices are already merging, which will support the process of signing up to the new contract.
I am the clinical lead for one of the Vanguard Sites where we are developing a Multi-Professional Community Provider (MCP). Much of what is described in the new contract, we are already delivering or are in the process of developing, and we have felt the benefits.
Our natural community is a population of 67,000 and seven practices. We are delivering a seven-day service through a GP provider company working with our community provider, based in the local hospital – it is seen as a branch surgery of the seven local practices, offering both routine and same day appointments from 8 am to 8pm. Local patients can book through their surgery or directly with the service, and the GP or nurse at the service can access their full practice record. This adds capacity to the local practices, assists in access both on the day during evenings and weekends and has the potential to reduce some of the unnecessary A&E attendances.
The service is staffed by a variety of GPs from partners in the participating practices, partners from practice outside the area, GPs who have left their practice and some younger GPs who have yet to decide on their career pathway. No one is ‘expected’ or required to work in the service.
If we create a better place for people to work and establish new roles that are attractive to newly qualified GPs as well as those who have been in practice for some time, we may start to retain one of our most valuable commodities and ease the recruitment and retention crisis. For example, younger GPs may want to do more urgent care, older ones might want to focus more on long-term conditions. Others may want to do education or research. With this new contract we can create these roles if they benefit the local health economy.
However, the truth is at the moment we don’t know if all GPs should sign up to this contract. A committee has been established to develop these proposals and produce the contract that will be on offer by April 2017, when we’ll know more for certain.
Nothing is without risk, but this new contract offers us the opportunity for greater flexibility and less micromanagement, potentially creating the conditions for general practice to thrive.
Dr Nigel Watson is a GP in the New Forest, a clinical lead in SW New Forest MCP and Chief executive of Wessex LMC.
Declaration of interest – I am a member of the committee charged with developing this new voluntary contract. This article is a personal view and does not necessarily reflect the views of the organisations that I work for.