Recommendation 1: There are significant opportunities to reduce the personal risk and unlimited liability currently associated with GP partnerships.
NHS England’s review of primary care premises should develop proposals to mitigate the personal risk associated with being a lease holder or property owner, and provide support and guidance to partnerships on property ownership (NHSE, GPC*)
- The government should explore the option of GP partnerships holding a GMS or PMS contract under a different legal model, such as limited liability partnerships and mutuals. (DHSC, GPC)
- The government and all relevant stakeholders must continue to support the final negotiations to introduce a state backed indemnity scheme in 2019, for all GPs and for those who work in and for practices. (DHSC, NHS England, BMA)
Recommendation 2: The number of general practitioners who work in practices, and in roles that support the delivery of direct patient care, should be increased and funded.
- Early career – A new employment opportunity for newly-qualified GPs, a primary care fellowship, should be launched by NHS England and Health Education England (HEE). This will support the development of primary care and community health staff in a range of areas appropriate to their future needs and the needs of patients.
- Mid-career - Improve career opportunities and training for future leaders (CCGs, STPs/ICSs, HEE, RCGP, NHS Leadership Academy)
- Late career - Funded time should be provided for GPs considering early retirement to undertake a variety of different roles which would support primary care. (NHS England, CCGs, HEE)
- The review encourages ongoing action by the government, GMC and other national bodies to streamline and simplify the process by which doctors are able to return to the UK to practice after working abroad for an extended period of time. (DHSC, GMC, HEE, NHS England, RCGP)
- A review of the current pensions arrangements for GPs should be undertaken, with clear solutions proposed to address the current negative impact on partnerships. (DHSC, HMT)
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Recommendation 3: The capacity and range of healthcare professionals available to support patients in the community should be increased, through services embedded in partnership with general practice.
- NHS England should expand and fund the wider general practice workforce working in practices and the local community, to support both patients and the GP workforce. (NHS England) HEE should further develop the role of Practice Nurses. (HEE)
- NHS England should support emerging primary care networks to make better use of the existing community health services workforce to support practices, by working more effectively with community health teams and by enabling the creation of population-based multi-professional teams across primary and community care. (NHS England)
Recommendation 4: Medical training should be refocused to increase the time spent in general practice, to develop a better understanding of the strengths and opportunities of primary care partnerships and how they fit into the wider health system.
- Medical students, Foundation year doctors, GPs in Specialty Training and other clinical professions with a clear opportunity to support primary care should spend more time in general practice and in community-based roles. (HEE, GMC, DHSC)
- Expand training opportunities for GPs in practices and in the community (NHS England, HEE)
Recommendation 5: Primary care networks should operate in a way that makes constituent practices more sustainable and enables partners to address workload and safe working capacity, while continuing to support continuity of high quality, personalised, holistic care.
- Primary care networks should be enabled to determine how best to address the balance between urgent and routine appointments during extended opening hours and weekends. (NHS England)
- The review supports the work of NHS England and other national partners to reduce unnecessary bureaucracy, but progress must be monitored closely, and further action must be taken to ensure successful implementation (NHS England, DHSC, and other national bodies)
- RCGP, GPC, NHSE and DHSC should develop an agreed strategy for the effective use of workload data, to support practices and partnerships to manage workload. (RCGP, GPC, NHS England, DHSC)
Recommendation 6: General practice must have a strong, consistent and fully representative voice at system level.
- General practice should be recognised by the GMC and government as a specialty. (GMC, DHSC)
- The recommendations in the report led by Professor Val Wass - By choice - not by chance: Supporting medical students towards future careers in general practice, must be implemented as soon as possible. (DHSC, GMC, other national organisations including HEE, RCGP, Medical colleges).
- Working at scale, for example through primary care networks, has the potential to improve and support general practice influence at a system level if the right incentives and expectations are put in place (STPs/ICSs, NHSE).
Recommendation 7: There are opportunities to enable practices to use resources more efficiently by ensuring access to both essential IT equipment and innovative digital services.
- There should be acceleration of current work to ensure universal, paperless and interoperable systems, and scoping of new, related work where this is resource-efficient. (NHSE, NHSD, DHSC)
- Practices would benefit from a streamlined digital platform which could be used to access and share common documents and information. Opportunities to streamline the extraction of information from GPs by other national bodies should also be considered. (NHSE, DHSC)
- Digital solutions should be introduced for every practice, that can support GPs and others working in primary and community care in their roles and career choices - including support for working at scale. (NHSE, GPC)
- The GP IT estate should be brought up to current standards of security and resilience, with appropriate support and training on relevant systems for all staff working in general practice. (NHSE, DHSC)
*Note: Brackets indicate organisations that recommendations are targeted at.