General practice needs reform to beat crisis, think tank warns

Funding for general practice has been slashed, more GPs are saying they will quit the NHS early, and GP trainee slots are becoming harder to fill, a think tank has warned.

GP consultation: report warns of pressure on the profession (Photo: JH Lancy)

A major report by think tank The Nuffield Trust into the future of general practice in England assessed concerns at the heart of the GP crisis.

Is general practice in crisis?, published on Tuesday, puts forward a number of recommendations for the reform of general practice, including use of the GP contract to encourage more practice mergers and federations, with larger GP organisations taking on the management of a wider range of healthcare services. It also proposes extra funding for ‘double running’ for a fixed period of time so that GPs can design and implement new models of care.

The Nuffield Trust’s report identifies that government funding for general practice fell by 3.8% (£287m) in the past year alone. One in 10 GP trainee slots were left unfilled this year, and it says there is evidence of a ‘looming staffing crunch’ in general practice, with more than half of GPs saying they will leave the front line within five years, an increase of more than one third since 2010.

GP reform proposals

The Trust’s proposals for the future of general practice tally with many of the recommendations in the recently published Five Year Forward View, produced by NHS England and five other central health bodies.

It envisages larger-scale general practice running a wider range of services, but it calls for this change to develop locally without top-down imposition of new models of care.

It suggests contracts should be used to support this vision of general practice, with the possibility of special contracts for practices treating patients with intensive health needs.

The report calls for extra funding for GPs during the 2015 to 2020 parliament to pay for innovation while continuing to provide existing services, and it wants a parallel workforce plan designed to train and retain more GPs, while deploying nurses and other healthcare staff to ease the existing workload on GPs.

GPs joining larger groups

The report’s author, Mark Dayan, said many GPs were already developing larger organisations, and that did not mean they were losing continuity of care with their patients.

‘Working in bigger, better organised groups can carry the important neighbourhood presence that many GP surgeries have through tough times,’ he said.

‘But it will need politicians to give GPs time and support as they make the switch to scaled-up general practice fit for the future.’

The Nuffield Trust also found that 99% of a panel of health and social care leaders it surveyed felt that general practice was either in crisis or needed reform.

The Trust regularly surveys the panel of 100 NHS managers and clinicians and senior social care staff on issues facing healthcare in the UK. Three out of four who responded said single-handed general practices were no longer fit for purpose.

The survey also found that 94% supported the concept of general practice federations, and over half backed more funding for general practice.

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