The Government has recently released the GP Forward View (GPFV). What does this mean for practices and primary care more widely? Although there are some encouraging signs, the document has been greeted with a mixed reaction and rather more muted enthusiasm than might have been expected. Why?
Firstly, it would have been good to paint the picture of the end game for primary care. What we have in the GPFV is a menu of interventions designed to shore up a crumbling General Practice. How should it feel in General Practice by 2020? What would the workload be and what would the range of services encompass? Without this sort of context – together with assurance that the hospital sector would regain financial sustainability – it’s difficult to see how primary care will fit; and that the promise of primary care rejuvenation and sustainability is achievable. Will this accelerate practices forming larger units; formally via merger, or just loosely, as at present, in federations? Or counterintuitively, will the GPFV prop up the status quo and slow transformative change in primary care? There is reference to the strength of independent contractor GPs but are we already too late to stop partners walking away from the business, financial and organisational risk they face currently?
Secondly, the GPFV does represent an acknowledgement that primary care is fundamental to the ongoing stability of the NHS. In fact the tone is really apologetic for the state that primary care is in. If hospitals are to get back into balance, much more needs to be done to prevent avoidable (and often non-contributory) work heading their way and at last this seems to have been acknowledged. We must kerb our cynicism regarding ‘double counting’ of investment and believe that NHS England means to do as it says.
Over a third of the document itemises schemes to increase workforce and reduce workload in General Practice. There is a section on how hospitals shouldn’t shift work to primary care, though it’s hard to see how writing such requirements into their contracts with CCGs will force behavioural change – we’ve seen repeatedly how blunt an instrument a contract is when dealing with a strong provider trust. Much is said about support with new professionals in primary care – surely some way off and without the range of diagnostic skills that come with GP training. Embarrassingly there is a tranche of measures to deal with the stresses and burnout present in the profession – hardly an advert for fresh recruitment – “Become a GP and we’ll provide mental health support once you’re stressed out”!
Lastly, it heralds some welcome and long overdue good news for General Practice. Jeremy Hunt’s obsession that primary care should serve a penance for the 2004 contract has brought it to its knees. An inadequately developed primary sector leverages extra pressure on the expensive secondary and tertiary components of the system and we have seen how reducing actual and percentage spend on primary care is matched by financial overspends in the hospital sector. We should have learned from areas in the world with capitated placed-based budgets that investment ‘upstream’ is essential to avoid crippling ‘downstream’ costs. General Practice is in crisis and although this intervention is very much ‘eleventh hour’ let’s hope that it, the NHS’ internationally admired ‘jewel in the crown’, is salvageable and that the GPFV represents a real and sustained change in policy towards General Practice and a recognition of its pivotal position in UK health care.
Dr Phil Yates