What the NHS long-term plan means for general practice
By Nick Bostock on the
8 January 2019
The NHS long-term plan has set out the government's vision for the health service over the coming years - GPonline picks out the key factors likely to affect general practice.
A 'shared savings scheme' will hand primary care networks part of any funding they save by reducing avoidable A&E admissions, admissions, preventing delayed discharge or reducing avoidable outpatient visits or over-medication.
The NHS plans to 'improve efficiency' in primary care, mental health and community health services - with a health service-wide 'cash-releasing productivity growth' target of 1.1%.
These 'network contracts' will sit alongside practices' existing GMS, PMS or APMS contracts.
Practices in networks will be funded through a 'designated single fund through which all network resources will flow'.
Most local enhanced services commissioned by CCGs will be moved into network contracts rather than deals with individual practices.
The QOF will undergo 'significant changes' - with a new 'quality improvement element' being developed in collaboration with the RCGP. Indicators deemed 'least effective' will be dropped, with new targets to be added to promote 'more personalised care'.
Standards, funding and procurement of GP vaccinations and immunisation will be reviewed with the goal of improving uptake.
Workforce
A 'workforce implementation plan' will be published later this year once the government has set a budget for training, education and CPD.
The government and NHS England remain committed to recruiting an extra 5,000 full-time equivalent GPs 'as soon as possible' and will develop incentives to boost numbers of doctors trained to match 'specialty and geographical needs, especially in primary care.'
Medical school places are already increasing from 6,000 to 7,500 a year, and options such as more part-time study places and accelerated four-year degree programmes will be explored.
Medical schools will be allocated training places based on 'the production of medical graduates who meet the primary care and specialty needs of the NHS'.
Newly qualified doctors and nurses entering general practices will be offered a 'two-year fellowship' under plans proposed in the GP partnership review, to provide a 'secure contract of employment alongside a portfolio role' designed to support the individual and the needs of the local health economy.
National scheme to support NHS organisations recruiting from overseas.
Integrated care
The plan promises to move all practices into networks to deliver 'fully integrated community-based healthcare' for the first time since the NHS was created.
Expanded community teams will be developed alongside networks, with a requirement for teams including GPs, pharmacists, district nurses, community geriatricians, dementia workers, physiotherapists, social care and voluntary sector staff to be brought together around network areas.
NHS111 will be able to book patients directly into GP practices and appointments at pharmacies from this year.
General practice will be linked more closely to care home support, with the NHS planning to roll out nationally its 'enhanced health in care homes' vanguard scheme. The scheme will link primary care networks to care homes, with named GP support for all patients and networks collaborating with emergency services on out-of-hours care.
NHS organisations
Integrated care systems (ICSs) will be rolled out across England by April 2021, 'growing out of the current network of sustainability and transformation partnerships (STPs)'.
The reform could lead to a dramatic cut in CCG numbers. There are 44 STPs, and the long-term plan says there will be typically 'a single CCG for each ICS area'. CCGs will become 'leaner, more strategic organisations'.
ICSs will have 'full engagement with primary care', with a named clinical director within each primary care network - and board-level representatives from networks.
Patients will have access to digital GP consultations 'usually from their own practice or, if they prefer, from one of the new digital GP providers'.
Health inequalities
An extra 110,000 patients will be offered physical health checks every year by 2023/24 - taking the total to 390,000.
Uptake of annual health checks in primary care by patients with a learning disability will be increased to 75%, and health checks for patients with autism will be piloted.
GP practices that are 'carer-friendly' will be awarded quality marks designed by the CQC.
The NHS will offer all smokers admitted to hospital smoking cessation support, alongside new initiatives to tackle diabetes and obesity, and targeting of funding at areas with the greatest health inequalities.
Cancer
Primary care networks will be required to boost early diagnosis of patients in their area by 2023/24, by ensuring GPs are using the latest NICE advice.
From 2020 a 'new faster diagnosis standard' will be introduced, with most patients to 'receive a definitive diagnosis or ruling out of cancer within 28 days of referral from a GP or from screening'.
Five-year cancer survival rates will be increased - with 55,000 more people surviving five years with cancer from 2028. The NHS plans to drive this improvement by building on 'work to raise greater awareness of symptoms of cancer, lower the threshold for referral by GPs, accelerate access to diagnosis and treatment and maximise the number of cancers that we identify through screening'.
The NHS has pledged to expand mobile CT scanning units to boost access to rapid screening, and rapid diagnostic centres will begin to be rolled out across England from this year.
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