But significant reforms could emerge from the consultation, after NHS England chairman Sir Malcolm Grant told the Commissioning in Healthcare conference in London on Tuesday that for primary care provision ‘we need to think the unthinkable’.
Funding needs to follow the transfer of work from hospitals to general practice, he said, but warned that GPs could face a ‘much more rigorous evaluation of outcome measures’.
Speaking ahead of the completion next month of NHS England’s consultation Improving general practice: a call to action, Sir Malcolm said that plans need to ‘transcend political timelines’ and operate over five- or ten-year terms.
‘I am not a person for a single model of primary care,’ he said. ‘I think we at NHS England are very interested to see what funding arrangements can bring a greater rationalisation to the provision of primary care.
‘I think that we will have a number of ways of approaching primary care.
‘The first is to look at what happens in different areas, in different regions. We have just appointed Professor Clare Gerada to come and help us in an advisory role in London. Primary care in London, for those who are not familiar, ranges from one or two practices which have 100 or more GPs working in them to 20% of practices that have just one GP in them.’
When asked by a London GP about the future of single-handed practices, which often have high satisfaction ratings, Sir Malcolm said: ‘Patient satisfaction is tremendously important but it is not everything. Life and death are everything and how competent a particular practice is in terms of the outcomes we can measure.
‘Dr Harold Shipman was one of the most popular GPs in his area.
‘We need to have a much more rigorous evaluation of outcome measures for primary care as we shall do for hospitals, as it is all part of understanding outcomes across the country.
‘For some activities you do need a consortium of some GPs to advance health education, public health, outcomes and screening and the other activities that we would like to bring into primary care and not maintain in hospitals. But there are many models of single-handed practices.
‘What I am interested in is not the number of doctors, it is the outcomes.’