It is at least on a par with community pharmacy for patient contact, undertakes 80% of all clinical consultations for under 10% of NHS monies, remains the most popular NHS-funded service and the evidence of its value is well cited.
The unique success of general practice in the UK is based on continuity of care serving a practice population. In fact, it is these unique attributes of the GP system that have lent themselves well to being the central plank of post-1990 NHS reform in England; GP fundholding, leadership of primary care groups, practice-based commissioning, all culminating in CCGs. So why throw the baby out with the bathwater?
A challenge for the future is to retain our heritage of being a local resource for our patient population while extending the range of services offered.
Furthermore, in being the major influence on clinically led commissioning to improve poor performance and enable provider development.
General practice needs to remain local and 'small', yet 'big' enough to be the strategically important NHS provider. Individual practices may lack the capacity or capability to provide an extended service, but if they are part of a locality or federation of provider practices, that organisation can provide the necessary strategic and operational management skills and staff.
And boldly for the future, I hope that CCGs will seek to devolve finances to localities and willing practices.
To pull many of these strands together, I developed the concept of the 'primary care home'. A home for all care professionals based on GP practice population(s) and commissioned to have budgetary responsibility to provide or commission services, known colloquially as 'making or buying'.
A provider as an alternative to the hospital focus - delivering extended care, yet allowing practices to retain their identity. The future for federations?
- Professor Colin-Thome was national director for primary care in England and is now an independent healthcare consultant.