Speaking at the launch of the Five year forward view, a plan for NHS services in the next five years, NHS England chief executive Simon Stevens said primary care would see a ‘much higher proportion of the NHS budget’.
The Five Year Forward View identified expanding and strengthening primary care as ‘one of the most important’ changes that needed to take place to improve the NHS.
The document says 'smaller independent GP practices will continue in their current form where patients and GPs want that'.
GPs could integrate with hospitals
But it sets out a range of NHS organisational models that local areas will be invited to adopt - which could see primary care integrated with hospitals in parts of the country.
One option set out in the report would see GPs combining services with nurses, hospital specialists and other community health services to form multispeciality out-of-hospital care providers.
Another would integrate hospital and primary care providers into joint 'primary and acute care systems', which would provide NHS list-based GP and hospital services together with mental health and community care services.
The new care models should be introduced over the next three to four years, Mr Stevens said, adding that ‘in an embryonic sense, many are already starting to take shape’.
Share of NHS funding
Mr Stevens did not rule out increasing primary care spending to 10% of overall NHS spending - a sharp rise from the current 8% - but did not confirm any figures. He said precise funding levels would be dependent on the next parliament’s overall NHS budget.
GPC deputy chairman Dr Richard Vautrey criticised the lack of detail in the plans. ‘What we need to see now is action taken,’ he said.
‘We’ve got a crisis now and we need resourcing now. We need to return the core funding of general practice back to the equivalent of 11% of NHS funding spent in general practice so we can deliver the needs of our patients and that’s the root of the problem.
‘General practice needs at least 11% of NHS funding just to do core work. If then we are expected or asked to do additional work on top of that, whether that be extended hours or doing more in the community, then there needs to be additional resource transferred to cover that as well.’
NHS structural reforms
The report suggests new ways of working could be incentivised through schemes similar to the Challenge Fund deal that has funnelled £50m to practices piloting extended opening from 8am to 8pm. It makes clear that a variety of models will be encouraged.
The report says: ‘Times have changed since the last such major blueprint, the 1962 Hospital Plan for England and Wales. What's right for Cumbria won't be right for Coventry; what makes sense in Manchester and Winchester will be different.
‘But that doesn’t mean there are an infinite number of new care models. While the answer is not one-size-fits-all, nor is it to let "a thousand flowers bloom".
‘Our approach will be to identify similar health communities and then jointly work with them to consider which of the new options signalled by this Forward View constitute viable ways forward for their local health and care services.’
Dr Vautrey welcomed plans to develop closer working relationships between primary care and other services without forcing them together and permitting different options.
The plan also highlights the importance of expanding the number of GPs in training ‘as fast as possible’.
‘We need to make general practice more attractive as a career choice for doctors in training. We want more GPs, and we need to change working arrangement patterns in order to do that,’ said Mr Stevens.
The Five Year Forward View was set out by the NHS leadership including NHS England, the CQC, PHE, Health Education England, Monitor and the NHS Trust Development Authority. It marks the first time the NHS has set out its own policy on its future.
