It says financial rewards and incentives to improve GP services risk being overused in the NHS and are not the best way to encourage lasting change and widespread reform. Policymakers instead need to supplement these financial incentives with a more enabling approach to improving general practice.
Transforming general practice: What are the levers for change? argues that this approach should involve developing new skills and working practices across the whole GP workforce, investing properly in equipping organisations to change and ensuring that better data is available to evaluate impact.
Blunt instruments which can detract from patient care
Author Dr Rebecca Rosen, a south-east London GP and senior policy fellow at the Nuffield Trust, said: ‘The history of reforming general practice in England is littered with initiatives aimed at achieving small-scale change through financial rewards. These can work well if the goal is to improve narrow areas of care. But they are blunt instruments, which can distort priorities and detract from patient care.’
The experience of four case study sites examined in the briefing suggested that the ingredients of successful service change include strong inter-professional relationships, capable leaders, time to experiment, and the willingness to take risks and sometimes fail.
Dr Rosen said: ‘Putting the Forward View into action will require policymakers to adopt a far more sophisticated approach to reform than the narrow use of financial rewards and contract changes. They need to be supplementing the use of these measures by building skills, understanding impact and creating the headspace that GPs need to fundamentally transform services.’
The Nuffield Trust concludes such an approach to reforming GP services should be based on better equipping the GP workforce to meet the changing needs of patients, including the development of specialist skills within primary care and cultivating strong leaders; ensuring that time to redesign and transform services is built into change programmes; and insisting on the development of a minimum dataset for general practice to permit a better understanding of impact.