The new GP contract is a significant moment for general practice. It builds on the commitments in the NHS long-term plan and GP partnership review, by putting general practice at the heart of the future NHS and helping to address the enormous pressures that GPs and their teams have been under in recent years.
The contract covers a vast range of subjects but here I focus on just two – the extension of team working and the emphasis on collaboration across general practice and wider community services.
Unlike the money attached to the GP Forward View, the contract channels new money directly to practices via core funding and the network contract directed enhanced service (DES), rather than practices having to bid for individual pots of money from CCGs (or national programmes).
Over the next five years practice funding will increase by almost £1bn and there will be a further £1.8bn to support the formation of primary care networks.
A significant amount of this network funding will be for investment in new staff working within general practice, including pharmacists, physiotherapists, social prescribing link workers, physician associates and paramedics.
This formal commitment to a multidisciplinary team approach in core general practice feels to be a significant shift. Just as contract changes in the 1960s and 1990s led to practice nurses becoming commonplace, this contract signals a fundamental change in how patients will experience general practice, expanding the GP offer to become much more of a ‘team sport’.
How these teams will actually work in practice needs careful planning and implementation if they are to have the necessary impact.
Another hugely significant change heralded by the contract is the formal development of primary care networks themselves as the building blocks of wider integrated care systems.
There are grand ambitions for these networks to become the organising structure for primary and community care. Community and mental health services will be expected to configure their services around primary care network footprints to deliver care to patients with complex needs.
GPs have long lamented the loss of dedicated district nurses and other community staff, who were moved from surgeries to central hubs, but the issues that drove that change – professional support; estates; economies of scale – still exist, and the new contract does not address these.
As with the expansion of team working within general practice, how primary care networks build effective working relationships and trust with wider community services will be crucial if they are going to deliver the ambitions set out for them.
The timelines attached to the development of primary care networks are extremely ambitious, and the scale and complexity of the implementation challenge should not be underestimated.
While many practices have already been collaborating in federations, clusters, and networks, the general practice contract places collaboration on a more formal footing. For example, primary care networks will require a single bank account and a legal agreement between the practices for the delivery of services.
In addition to this formal legal agreement between practices, networks will be encouraged to get the sign-up of wider partners, including community, mental health and voluntary sector providers. All the evidence shows that successful working at scale requires deep trust, strong relationships and a shared vision and values.
Embryonic networks may well need significant support to develop and sustain the kinds of working relationships that will be required, both between the practices in a network, and with the wider system.