As we mark the first anniversary of the publication of NHS England’s GP Forward View (GPFV) and head into conference season it is timely to review the progress made on the promises from NHS England to address the crisis in general practice.
The GPFV was NHS England’s response to the GPC’s own paper 'Responsive, Safe and Sustainable: Our Urgent Prescription For General Practice' (UPGP). It set out the necessary basics of a recovery plan to deliver safe and manageable workloads by providing more time with patients, increased practice funding, more staff and less red tape.
The GPFV responded to many of those demands and the delivery of every penny of promised funding is an absolute minimum requirement if we are to begin the process of recovery in general practice. Of course, the GPFV by itself is not the entire solution to our problems.
Much parallel work has been done through other mechanisms such as contract negotiations to ensure investment and decrease box ticking. The GPFV remains, however, the foundation on which other initiatives are being built, such as the introduction of the new standard hospital contract designed to release GPs from time-consuming bureaucratic burdens more appropriately placed on hospital management.
It is clear that the central leadership of NHS England now understands the perilous state of general practice and we have seen a genuine desire from them to engage meaningfully to deliver improvement. It is equally clear that their understanding is not shared uniformly by their local and regional staff and this has led to unacceptable variations in delivery.
Identifying this patchy performance has been hampered by the complex structure of the GPFV with many small hypothecated budgets - a structure that, with rapier irony, was compared at a recent meeting to trying to redecorate your house entirely with match pots.
On the ground, regular meetings between GPC, NHS England and LMCs will continue to hammer out any inconsistencies in delivery but it is clear that we face a significant challenge in changing the culture within local management that too often still regards general practice as an 'all you can eat buffet'.
And as many GPs will know only too well, whether politicians fully understand the daily challenges we face is an open question. We are awash with warm words, especially as this conference takes place in the midst of a general election campaign, but after years of neglect general practice needs political action that supports the good intentions of those on the ground.
The GPFV will only be delivered properly with the unambiguous, full throttle backing of the next government and patients, as well as GPs, are frankly tired of waiting for this to happen. It is an issue that should not be ducked in this election.
The GPFV, if implemented fully and without game playing, will be the foundation for recovery and along with the many other initiatives pursued by GPC will answer the demands of UPGP. But there is no margin for error. LMCs and GPC must work together closely to identify areas where performance against GPFV is not acceptable and demand action. The plan exists. Nothing but full implementation in every patch will do.