NHS reform: STPs are wrong to accept reduction in GP numbers

Sustainability and transformation plans (STPs) in parts of England are planning for a significant reduction in GP numbers. Despite welcoming greater skill mix, Chartered Society of Physiotherapists chief executive Professor Karen Middleton says allowing GP numbers to fall is a big mistake.

Chartered Society of Physiotherapy chief executive Karen Middleton
Chartered Society of Physiotherapy chief executive Karen Middleton

Proposals in London and Somerset that plan for a sharp reduction in GP numbers as part of their sustainability and transformation plans (STPs) snatch defeat from the jaws of victory.

By doing so, they risking missing the chance to bring about - at scale - the best hope for delivering the kind of change the STP process was set up to achieve.

The argument is that other professions, including physiotherapists, can pick up the work traditionally done by GPs and that is true - to an extent.

Four in 10 CCGs now have at least a pilot scheme where physiotherapists are seeing patients as a first point of contact in GP surgeries.

GP workforce

This is good for the patients but also something that delivers system-wide benefits for the NHS by cutting admissions to hospital while reducing orthopaedic referrals.

Furthermore, it is a successful model for supporting the growing numbers of people with a long-term condition to self-manage, thereby reducing demand for health and social care services.

So the expanded team in primary care is absolutely the right way to provide better care for patients.

That’s why the BMA and RCGP worked with us to produce new guidance on how to implement such roles.

But in those areas, the emphasis is very much on collaboration in the best interests of patients and the system, not substitution on financial grounds.

The truth is, we need more GPs, not fewer. And more physiotherapists. Some 500 more a year, in fact.

Podcast: what do STPs mean for GPs?

Attacking the problem like that is the only way to deliver change on a scale that not only meets the immediate challenge, but actively goes further and transforms the way the NHS delivers care.

We can not only meet growing demand with better supply, but then use that supply to reduce demand over time.

So viewed in that context, the proposals in Somerset and London to broaden the offer to patients are welcome – they just don’t go far enough.

As ever, it comes back to money and that throws into stark relief the big problem for those who are drafting STPs.

However innovative some of their solutions may be, they keep coming up against a lack of funding to deliver them properly.

The irony is that investing upfront would increase the sustainability of the NHS by reducing costs down the line.

But without the political will to create – and protect – a transformation fund of sufficient size, it cannot happen.

For all the controversy around STPs, they remain a genuine opportunity to bring about the change that can provide more care closer to home and in a way that works best both for patients and for desperately-stretched budgets.

We must be brave and grasp that opportunity - but we need more GPs to do it, not fewer.

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