I warmly welcome NHS England’s publication of the General Practice Forward View. It represents a genuine desire by NHS England to put in place significant measures to not only relieve the acute pressure that general practice is under, but also re-vitalise and invigorate the front line workforce.
A significant number of member organisations, including the New NHS Alliance, have had the opportunity to feed into plans. This recognises that it’s not just about GPs, but about the whole of the general practice workforce, including non-clinicians.
We are delighted that all of our recommendations to reduce workload in our report Making Time in General Practice, produced in conjunction with The Primary Care Foundation, were highlighted in the GP Forward View. You can read the report here.
Looking at the positives
There are many other positives to reflect on. The proposed investment of over £2bn additional funding, year on year, will go a long way towards reaching the desired 11% of NHS funding in the next five years. The issues facing general practice are more complex than funding and it is very encouraging to see that measures are also being put in place to recruit, retain, educate and develop both clinical and non-clinical staff.
While the plan to attract an addition 5,000 GPs by 2020 is ambitious, hopefully the GP Forward View will encourage medical students and doctors in training to see general practice as a viable and attractive career. It is also welcoming to see the recognition of the importance of primary care mental health staff, with funding promised for an additional 3,000 mental health therapists by 2021.
General practice nursing, practice management, and the role of clerical staff have lacked a sense of direction, focused education, and structured development for too long. The emphasis placed on this in the Forward View through the proposed new national development programme for practice managers and the training and development of practice nurses is critical in bringing their recruitment, retention, and professional fulfilment forward.
I also welcome the plans to place more clinical pharmacists into general practice. I see the GP Forward View as a big step forward towards the multi-disciplinary approach, involving community pharmacy, eye care, and many other essential services in primary care, which is especially needed for complex patients.
So, what’s lacking?
The major unresolved issue remains indemnity. I appreciate that this is a very complex area, and that there are no easy, readily affordable fixes. However, the issue of indemnity remains one of the major factors of many GPs’ decision to leave the profession.
Although the measures included in the GP Forward View will help some, especially federations and other new provider models, there is very little here for the individual GP who faces soaring indemnity costs, especially those working in urgent care settings.
Another issue is that the GP Forward View will be of little comfort to the practices who are really struggling in the here and now. 2020 will seem a long way off for them, specifically practices in areas of high demand due to high deprivation and health inequalities. The promised review of the funding for practices needs to be undertaken as a matter of urgency if it is to help these areas.
Lastly, I would have wanted to see a vision for the whole of primary care laid out in the Forward View. A vision for integrated services across health and care providers, communities, housing and local government. I believe that it is this integration that would truly energise the whole of out of hospital care, not just general practice.
There is a lot to welcome in the GP Forward View, and I believe it presents us with a real starting point to relieve the acute pressure that general practice is under, but we must not forget that there are still some important issues to be addressed, and much still to do.
The New NHS Alliance is committed to working with NHS England and other organisations to make these initiatives a reality. We will however watch progress carefully and hold the centre to account for delivery, ensuring that the money is spent in the areas that it is intended, and delivering what we all want for our colleagues and staff, and most importantly for our patients and communities.
- Dr Mark Spencer is a GP at the Mount View Practice, in Fleetwood, Lancashire and co-chair of the New NHS Alliance