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Partnership best model for delivering what GPs and patients want

We need more GPs – current model of NHS care too focused on hospitals, and is unsustainable

Louise Prime

Tuesday, 15 January 2019

We must fund an increased number of GPs working in direct patient care, and medical training should be refocused to increase the time spent in general practice, according to an independent review published this morning. Its authors warned that the current ‘unsustainable’ model of care in the NHS is too dependent on hospital-based care, and that we cannot move forward without including general practice and partnerships at the heart of change.

The BMA and the Royal College of GPs (RCGP) both welcomed the report’s verdict that the partnership model must be given greater support to ensure its survival. But the BMA warned that we should “be under no illusions” about how much time, action and commitment will be needed from government and health bosses to implement the recommendations against the current workforce crisis.

In February 2018 Jeremy Hunt, then secretary of state for health and social care, commissioned an independent review into the partnership model of general practice. Chair of the review team, GP partner (and chair of Wessex Local Medical Committees) Dr Nigel Watson, told the current health and social care secretary Matt Hancock and NHS England chief executive Simon Stevens today: “General practice needs to feel valued and requires new resources to expand the workforce and address the workload it faces now, let alone in the future… We also need a clear vision of the vital role general practice and primary care must play in a future NHS. Partnerships need to own this vision, and lead the change that is required to create and promote a positive future for general practice.”

In his foreword, Dr Watson called for a better balance between continuity of care and access to services. He insisted: “‘Relational continuity’ is at the heart of general practice, valued by patients and GPs alike and shown to deliver better outcomes.”

He warned: “The current model of care in the NHS is too dependent on hospital-based care. This model is not sustainable, and we cannot move forward without change that includes general practice and partnerships at its heart. We are moving towards a team-based multidisciplinary way of delivering care, which must involve general practice working more closely with colleagues in primary, secondary and community care and ensuring we make the best use of all our skills.”

Dr Watson pointed out that although the partnership model is not dead, with many practices that are working as partnerships delivering high quality, person-centred care and expanding their services, partnerships have recently become less popular with GPs and there is a risk the model could be lost without both the continued commitment of existing partners and the input of new partners. He added: “It is important that a plurality of sustainable alternative models are available where the difficulties of recruitment and retention mean that a partnership model cannot thrive.”

He noted that hospital services have lately had an increasing share of the NHS budget at the expense of general practice, community services and mental health, and said: “The additional £4.5bn of investment for primary and community care recently announced in the NHS Long-Term Plan is, therefore, a welcome step in the right direction, which will need clear local commitment as well as national.”

Dr Watson concluded: “There is no single, simple solution. The challenge is about reducing workload to a manageable level; expanding the workforce to support staff, patients and the system; reducing unjustified risk to individuals; and providing a high quality, person-centred service that GPs and others working in primary care find varied and rewarding, now and in the future.”

The report’s key recommendations are:

  1. There are significant opportunities that should be taken forward to reduce the personal risk and unlimited liability currently associated with GP partnerships.
  2. The number of general practitioners who work in practices, and in roles that support the delivery of direct patient care, should be increased and funded.
  3. The capacity and range of healthcare professionals available to support patients in the community should be increased, through services embedded in partnership with general practice.
  4. Medical training should be refocused to increase the time spent in general practice, to develop a better understanding of the strengths and opportunities of primary care partnerships and how they fit into the wider health system.
  5. Primary care networks should be established and operate in a way that makes constituent practices more sustainable and enables partners to address workload and safe working capacity, while continuing to support continuity of high quality, personalised, holistic care.
  6. General practice must have a strong, consistent and fully representative voice at system level.
  7. There are opportunities that should be taken to enable practices to use resources more efficiently by ensuring access to both essential IT equipment and innovative digital services.

The RCGP welcomed the “optimistic and pragmatic” report’s focus on reducing unnecessary workload in general practice and increasing both the GP workforce, and the wider practice team, as well as reducing the bureaucracy involved with Care Quality Commission inspections, appraisal and revalidation and GDPR compliance.

College chair Professor Helen Stokes-Lampard argued: “Ultimately, no model of general practice will be sustainable without sufficient numbers of GPs and our teams, so the recommendations to implement fellowships for newly qualified GPs, extend and enhance the GP retention scheme, and ensure the GP training budget reflects the true cost of delivering placements in general practice, are all also welcome – as is the recommendation to ensure the status of general practice by formally recognising it as a specialty.”

The BMA said it was pleased the report highlighted the increasing pressures placed on GPs partners and the growing risks and liability they carry; and it called on the government to take these seriously, for example by supporting changes to indemnity and producing tangible proposals for reducing the risks inherent in owning and leasing practice premises.

Chair of the BMA’s GP committee Dr Richard Vautrey commented: “The recommendations to address the long-term perception about general practice are particularly important to implement, enabling more doctors to experience general practice as part of training and giving more GPs the opportunity to learn more about what being a partner involves.

“We should be under no illusions, however… there is no miracle cure or panacea within this report. Dr Watson’s recommendations will take time to implement, and decisive action and long-term commitment from ministers and health bosses, building on pledges already made in the NHS Long Term Plan, are required if we are to see the meaningful change both doctors and their patients desire, and a partnership model fit for generations to come.”

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