Speculation has recently arisen over the “nationalisation of general practice” after a letter leaked to the Times stated that health secretary Sajid Javid is planning “an independent review of the future of primary care”, to look at “workforce, business models and how GPs work with the other parts of the NHS such as hospitals”.
GPs are not complacent, neither are we averse to change, and something needs to be done. But it is not the model of general practice that needs an overhaul, and proposals to disrupt, or even destroy, a system that has served patients and the NHS well for generations would be a catastrophic step backwards, rather than securing a sustainable future for the profession and the people we care for.
The real problems that need addressing are historic underinvestment in GP services and poor workforce planning. What needs radical thought is how the Government can make good on its 2019 manifesto pledge of an additional 6,000 GPs and 26,000 additional practice staff by 2024, so that GPs and our teams can continue to deliver the care our patients need and deserve, now and in the future.
General practice is the bedrock of the NHS. It delivers the majority of NHS care, close to home where patients want it and where it is most cost-effective. In turn, this alleviates pressures elsewhere in the health service.
And it is the business model under which NHS general practice operates that facilitates this. Working as what are in effect partners in a business contracted to the NHS, GP practices are able to tailor their services to their local populations, so that patients receive a personalised service that best meets their health needs. A practice in rural Devon, for example, like one I used to work in would offer different services to Moss Side in Manchester, where I’ve also practised, and again in East London where I practise now.
It allows GP teams to innovate in order to deliver tailored and optimal care to their local populations. As well as the care and services it provides for patients, it is good value for money for the NHS and for the taxpayer, and a recent independent review of the GP partnership model found it to be a viable one.
As former NHS Chief Executive, Lord Stevens, has noted: “the strength of British general practice is its personal response to a dedicated patient list”.
When people speak about their doctor, they are invariably talking about their GP. In many cases this is the doctor they take their children to see, or who looks after their elderly parents. Relationship-based care is at the heart of what we do and delivers the best outcomes for patients. A recent study published in the British Journal of General Practice confirmed the vital importance of continuity of care for dementia patients.
It is why GPs are consistently rated amongst the most highly-trusted professionals in society; and why patients consistently report high levels of satisfaction with the service even when it is under huge pressure. And this is possible, because GPs have the freedom to make decisions in the best interests of patients and build and maintain relationships with them over time in a way that is cost-effective for the NHS.
But the service is struggling. It was before the pandemic and the crisis has only exacerbated it. The size of the qualified workforce fell by almost 6% between September 2015 and August 2021 while the number of patients has continued to grow, meaning that the ratio of patients to GPs has increased by more than 10%. GPs and our teams are consistently delivering more patient consultations than before the pandemic; taking into account multiple mass vaccination drives, an unprecedented 367 million consultations were made in general practice in England in 2021.
Whilst we would welcome an NHS that is less fragmented and can work most efficiently as a whole, proposals that seem to want to give hospitals more freedom, and general practice less, do not represent coherent policy. We are keen to look at ways in which the NHS can be sustainable for the future, but any changes or ‘reform’ must be in the best interests of our patients, general practice, and the wider NHS.
These mooted changes also display some ignorance about how the NHS works. The detail is less of a concern to me – it’s the preoccupation of policymakers with hospitals that are a cause for concern. When politicians talk about NHS pressures, they are invariably talking about hospitals being overwhelmed. But general practice is overwhelmed and if general practice collapses, the rest of the NHS will follow closely behind.
A commission chaired by Baroness Finlay in 2013 found that GPs were so important in the NHS that “if they did not currently exist, they would have to be invented”.
I couldn’t agree more. So let’s stop the meddling and trying to fix what isn’t broken – and focus instead on getting our hardworking GPs the support they need to give all their patients the best care possible.
