GPC embraces reform and demands investment to modernise general practice

GP leaders have demanded a 'sustained year-on-year increase' in the share of NHS funding for general practice, in a blueprint for a sustainable service that backs more primary care 'at scale', recognises the limitations of independent contractor status and challenges the government's vision of a seven-day NHS.

Dr Chaand Nagpaul: 'General practice is at a crossroads'
Dr Chaand Nagpaul: 'General practice is at a crossroads'

In a 40-page report that draws heavily on the BMA's largest ever poll of the profession - which lifted the lid on soaring workload and crumbling morale - the GPC backs new models of care, demands action to tackle recruitment and retention problems, and investment in premises, infrastructure and technology.

GPC chairman Dr Chaand Nagpaul told GPonline the report was a 'formal investment strategy' that aimed to achieve a sustainable future for a profession that is 'at a crossroads'.

The GPC report challenges the government stance on seven-day GP services, warning that patients - like GPs - are unconvinced that better access is 'best provided by a seven-day routine service across the NHS'.

The report calls for funding from the £150m prime minister's challenge fund to be redirected to develop existing urgent care rather than to create a 'parallel routine service'. It demands the integration of urgent care across 111, GP out-of-hours and urgent care centres, with fixed minimum staffing levels for out-of-hours organisations.

New models of care

The independent contractor model of general practice 'needs to evolve', the report Responsive, safe and sustainable: Towards a new future for general practice warns.

It cites BMA polling that found 'overwhelming support' among GPs for independent contractor status to remain, but acknowledged that 75% of salaried and locum GPs under 30 years old do not plan to become partners.

'Independent contractor status does not necessarily equate to ownership of and buying into a practice,' the report says. 'Indeed, it is possible that increasing opportunities for GPs to become partners without this financial responsibility will encourage younger GPs to become partners, with all of the benefits to the health service that this entails.'

The government's approach to the GP contract is heavily criticised, with short-term 'government-driven contract initiatives' such as access targets, some DESs and QOF targets highlighted as unsettling and a factor in low GP morale.

GP contract reforms

The report says: 'We believe there should be a move to a long-term, consolidated and stable GP contract. This would provide a core of essential GP services that all practices have to offer to patients on their registered list and thus provide consistency for all patients, a solid foundation upon which to build other services, and a ring-fence to protect GP services in any integrated care model.'

Larger GP practices employing a wider range of staff and offering a greater array of services are also backed in the GPC report, with practices urged to join federations or networks.

Dr Nagpaul said small practices could survive if they linked up with wider services. But the report makes clear that isolated small practices must be phased out: 'Other than in remote and rural areas, practices should be large enough to offer a full range of services and have a large enough workforce to be able to deliver these services in a sustainable way.

'It is clear that working in some form of network or collaboration is key to both the sustainability of practices and the better management of GPs’ workloads.'

The GPC report sets out a list of key principles: 

  • Ensure patients have access to a local GP practice run by a healthcare team they know and trust.
  • Reduce GP workload to a safe level in order to deliver quality care.
  • Resources should match where care is delivered.
  • Retain and value the skills of the GP as a specialist generalist, enabling them to provide a holistic approach to care for all their patients.
  • Build health and social care teams around each practice.
  • Support practices to work in collaboration with one another and other local health and social care providers for the benefit of the whole population in that area.
  • Empower patients as partners in their care, giving them greater confidence to undertake more self-care.

Dr Nagpaul said: 'General practice is at a crossroads after a decade of rising patient demand and falling resources. Nine out of 10 GPs report that workload pressures are damaging the quality of care they can deliver to patients.

'Rather than focusing on piecemeal changes or unrealistic politically-driven plans like compelling practices to open all week when they have neither the resource nor capacity, we need a meaningful programme of reform which creates a sustainable, modern and flexible service. We need better, more focused ways of lessening the overwhelming workload undermining GP services through better self-care, effective use of new technologies and appropriate funding.'

He told GPonline: 'This is a framework for investment. The government has said it recognises that GPs have been under-resourced. There hasn’t been the political will to address some of the key issues paralysing general practice, or the investment. We need more money, and this is how it can be spent.'

A DH spokeswoman said: 'Many of the recommendations the BMA is calling for are already happening. We're investing £1bn in improving surgeries across the country, we're investing £150m in testing out new technology to improve services and we've committed to delivering 10,000 more primary care staff by 2020, including 5000 more doctors in general practice. On top of this we're backing the NHS's own plan for the health service with an extra £8 billion a year by 2020.'

Photo: JH Lancy

Download the report here

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