Jeremy Hunt: State indemnity deal and workforce reforms key to tackling GP crisis

Writing exclusively for GPonline, health secretary Jeremy Hunt spells out how the DH will support general practice with a state-backed indemnity deal and measures to strengthen the primary care workforce, following his keynote RCGP annual conference speech.

Last month, we got the definitive verdict on general practice in England, as the CQC delivered its State of General Practice report. This was the biggest ever review of the profession, based on more than 7,000 inspections over two years, and its conclusion couldn't be clearer.

Despite formidable pressures, 90% of all general practices are delivering good or outstanding care, while 80% of those rated inadequate or requiring improvement have subsequently improved. It underlines why general practice remains the highest rated of all public services when it comes to public satisfaction.

Yet as encouraging as the report may be, it shouldn't distract us from the very real challenges facing the sector. Which is why, as I speak to the profession today at the RCGP annual conference 2017 in Liverpool, I'll be setting out measures to strengthen general practice and acknowledge the pivotal role it plays in making our NHS the best healthcare system in the world according to the Commonwealth Fund.

GP funding

Funding is critical, which is why in the last year real-terms funding went up 3.2% - the fourth successive year of real-terms growth. But even more fundamental is the question of capacity – which is why I still want to see 5,000 more doctors working in general practice.

The first priority has been to secure the next generation of GPs and we have set a target to increase the number of GP training places to 3,250 each year. Last year, we had 3,019 new starters into training posts, our highest number of trainees ever, and the early signs for this year show that we are on track to exceed this and meet our target.

Future recruitment into specialty GP training will be further supported by the 1,500 additional medical school places we're now funding over the next two years. This should put us on track to create the biggest pipeline of trainee GPs in the NHS's history.

But given the time it takes to train a GP, there are still going to be some shortfalls. So to relieve the pressure more quickly we are increasing the recruitment of overseas doctors. NHS England will be setting up its first ever international office to co-ordinate recruitment, with a view to recruiting 2,000 doctors over the next three years.

We will do so with clear principles in mind, namely the highest standards of clinical practice will be maintained and all ethical codes around international recruitment will be respected. We will also seek to attract UK-trained doctors back as a first priority while making sure UK-based doctors don't lose out as a result of the programme.

GP workforce

One of the striking things about the current state of general practice is the huge variation in workforce supply across different parts of the country. There are particular areas (notably the North East and particularly rural and coastal areas) where there are critical shortages, while other parts of the country (London and the South East) are comparatively well-stocked, albeit with some local variation.

So the third thing we will do is create a more level playing field when it comes to supply, including targeted salary supplements of £20,000 in areas where they have failed to recruit trainees. And because there is a link between where students study and where they choose to work, Health Education England will ensure many of the extra medical places are focused on geographical areas that we struggle to recruit into.

Yet by far the biggest challenge is retention – and making sure that despite the huge pressure on the frontline general practice remains a rewarding and fulfilling place to work. There are a number of things individual practices can do to reduce burnout – in particular implementing the NHS England 10 high impact actions, which save significant amounts of GP admin time as well as reducing inappropriate appointments.

But the government can also help by confronting the steep and unpredictable rises in indemnity subscriptions. The rising value of claims mean that the average GP now pays around £8,000 a year on their clinical indemnity cover, a significant reason why some GPs decide to leave the profession.

Contract reform

I have therefore now decided that a state-backed indemnity scheme is the best option to provide stability, value for money and meet the needs of current and future GPs. We will work with the GPC, the RCGP and the four medical defence organisations to find the best way forward, but I want a system that is both more stable and more affordable than the current one. If agreement can be reached I would like to make changes in the 2018/19 GP contract so that the changes can come into effect in April 2019.

Finally, because the strength of primary care lies in its ability to draw on a diverse range of backgrounds and experiences, we need to do more to improve the support network around the GP.  We've already said that we want to attract a minimum 5,000 additional staff into primary care by 2020, with plans to grow other parts of the community workforce, including pharmacists and mental health professionals, over the coming years. We now just need to make it happen.

Over the last 70 years, our extraordinary network of GPs and primary care professionals has set the NHS apart as a healthcare system. But we have neglected the potential of general practice for too long so I hope these wide-ranging plans will confront some of the biggest challenges facing the profession.

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