When people outside the UK are asked what they most admire about the NHS, alongside equitable access to care sits our highly developed network of GPs and primary care.
This week we received yet another reminder of this in the extraordinary response of local GPs and other community health professionals in responding to the tragedy of Grenfell Tower. But of late GP morale has been lower than we’d like, some GPs themselves have felt undervalued and workloads continue to grow.
So, two years ago, in my first speech after the 2015 general election, I described the "new deal" I wanted to strike to help recruit and retain the best in general practice, and to ensure it remains able to play its essential role in our NHS. That was followed by the GP Forward View, committing the NHS to a £2.4bn (or 14%) real-terms increase in the budget for general practice.
What progress has been made since then?
First, there has been concrete recognition across the system that we need to increase the capacity of general practice to deal with the increasing workload. Some were sceptical of my pledge to increase the number of doctors working in general practice by 5,000 – but just because it is a challenging target doesn’t mean it isn’t the right thing to do.
GP training places
Since then, we have widened the pipeline of medical students entering GP training, seeing the numbers entering GP training up by 9% since 2015. The 3,250 trainees we want to enter training this year – an increase of around 7% on the numbers entering training in 2016 – will represent the biggest cohort of trainee GPs in the NHS’s history. We’re also making general practice a big priority for the expansion of medical training places by 1,500 a year from 2018.
This is supported by targeted efforts to attract GP trainees to work in areas of the country where places have been unfilled – a successful scheme that we’re expanding this year.
But for all these efforts to boost recruitment into the profession, we know that the most urgent challenge is the retention of existing GPs. We need to reduce the high turnover rate across general practice, both by encouraging those considering retirement to stay on and reducing the numbers choosing to leave for other reasons.
Already in existence is the £1 million GP Career Plus scheme – which will give GPs more flexibility over their working lives, provide services to treat long-term conditions and act as mentors to less experienced GPs. A pilot phase is already underway in 11 parts of the country, but this is something we expect to roll out more widely in the years ahead.
We are also looking to reduce GP burnout by opening up new ways of diversifying and supporting the existing skills mix of established primary care professionals. Many practices are already using combinations of physician associates, paramedics, advanced nurse practitioners, community pharmacists, therapists and allied health professionals to help them manage the increased demand.
In places like Norwich, where pharmacists are working with five practices to support GPs, or in South Somerset where GPs are working hand-in-hand with local acute providers to boost self-care we are seeing a new level of collaboration as a result.
GP contract
Through the GP contract, we are seeking to respond to the many legitimate pressures facing practices – not least the rising cost of indemnity, which I know is an area of particular concern.
Following the GP indemnity review, additional money was included in the contract last year, to address indemnity inflation. And in March this year, the government committed to working with GPs and indemnity providers to ensure that appropriate funding is made available to meet additional indemnity costs to GPs this year.
More broadly, the contract takes important steps to reduce bureaucracy for GP practices and provides greater rewards for looking after frail and elderly patients.
Most of all, we want to make sure everyone in general practice and considering it as a career knows one simple truth: that the transformation of the profession is at the heart of the changes we are championing in the NHS as we embark on possibly the biggest shift to integrated care of anywhere in the Western world.
We want a system that focuses on prevention, not cure – and without our army of GPs it will be impossible to make that vision a reality. Whether it is by leadership of CCGs, setting up new Primary Care Homes and MCPs or new federations of practices, GPs are leading this change – but now we need to see the revolution spreading everywhere.
None of this will happen overnight. Sustained increases in capacity take many years. But we are beginning to turn the corner – and I want general practice, alongside mental health, to be the part of the NHS that sees the biggest patient-facing improvements in the NHS over the next five years.
