General practice jewel in NHS crown – but needs fundamental change

Author: Louise Prime

General practice is the jewel in the NHS’s crown but needs fundamental change to overcome the many challenges that it is facing, the Institute for Public Policy Research (IPPR) has declared. The Royal College of GPs (RCGP) insisted that the partnership model of general practice works in the best interests of local populations and also provides excellent value for money for the NHS – and that scrapping the model won’t help workforce targets.

The IPPR report*, published this morning, said there is evidence that a strong primary care sector –with multidisciplinary teams including nurses, pharmacists, mental health specialists and allied professionals – delivers better health outcomes, reduced utilisation of hospitals and emergency departments, and slower growth in health care spending. But it argued that general practice in England needs “fundamental change” to overcome problems such as significant variation in quality, poor access, increasing GP workloads and changing demographics.

The IPPR reported: “There is a growing consensus that a shift towards primary care at scale [50,000-100,000 people] – what we call the ‘neighbourhood NHS’ – is the solution to these problems. Recent government reform initiatives have made some progress in delivering on this vision, but the evidence suggests there is much further to go.” It contended that resulting economies of scale would make it cost effective to invest in longer opening hours, diagnostics and treatment in the community, and a wider team of healthcare professionals to support the GP in delivering integrated care. The report’s authors said: “There is growing evidence this delivers higher quality care as well as improving access and relieving workforce pressures on the GP.”

The charity – which calls itself “the UK’s pre-eminent progressive think tank” – called for a “new deal” to allow general practice, which it said should be made up of four main components across England:

  • Create neighbourhood care providers (NCPs) to deliver the “neighbourhood NHS”.
  • Offer all GPs the right to NHS employment.
  • Reform new GP roles to create career progression, time to care and realistic workload.
  • A radical transformation of the primary care infrastructure.

But the RCGP argued this morning that the partnership model of general practice, within a mixed and flexible economy of contractual models, allows GPs to innovate in the best interests of local populations and in fact provides excellent value for money for the NHS – and that scrapping the partnership model would not help to meet workforce targets.

College chair Professor Martin Marshall said: “We are also optimistic about primary care networks, which sound similar to the NCPs advocated in this report, and PCNs and the partnership model are not mutually exclusive – it is essential that partnerships work effectively with and within PCNs to deliver high-quality place-based care to patients. However, PCNs need to be given the time, space and support to effectively develop and to build connections within the wider NHS system, in order to deliver place-based care that meets the local needs of their patients.

“Scrapping the partnership model is certainly not the solution to the pressures facing general practice, improving patient access, or meeting the government's target to build the workforce by 6,000 full-time-equivalent GPs.”

He pointed out: “Last year’s independent review into the partnership model clearly stated that it is an important model, and viable career option for GPs at all stages of their careers – but that there are key issues that need addressing, most salient being the need to reduce unnecessary workload in general practice and expand the workforce.

“The new GP contract, published yesterday, is a step in the right direction and financially supports GPs into partnership roles through a new scheme. We also need the forthcoming NHS People Plan to include comprehensive plans on how they plan to train and recruit more GPs and other staff, as well as retain existing GPs in the profession and encourage more GPs into partner roles – and tackling ‘undoable’ workload should be a starting point. On top of this, we need to see continued support for PCNs to be allowed to achieve their potential.”

*Thomas C, Quilter-Pinner H. Realising the neighbourhood NHS: delivering a new deal for primary are England. IPPR, published online 1 February 2020.