In recent months, GP Leaders along with the Government have been working tirelessly to ensure that a new strategic direction for the future of Primary Care is realised. This has come in the wake of what appears to be an endless release of new or changed policies, reform, documents and promises of investment to improve the current state.
The challenge of overhauling the system to efficiently meet the increasingly co-morbid health needs of the UK population is extremely complex. Even more so when one considers that quality care and patient and staff experience are the core values driving the work-streams. Its success is dependent upon lots of diverse microsystems (GP surgeries), working collectively and cohesively in the best interests of patients, colleagues and national health. Many GPs out there do think reform is possible, despite seeming like an unsurmountable task at this stage, and of the recent literature reviewed a lot of the successes are aimed at ensuring that;
- Primary Care is sustainable for the local populations for which they serve and that the health needs of the local population reflect what the GP surgery can offer without one size to fit all.
- The role of the GP is one that appeals to the future medics of tomorrow, but at the same time proves attractive enough to entice back those who have left the profession.
- GPs are given time to spend some of their professional working lives freed up from only patient facing activities so that they can provide leadership on improvement, strategy and service development.
- Workloads don’t cripple the system that they are so desperately needed to support, by ensuring that work that can be completed by another suitably trained professional is completed by that professional. It doesn’t have to remain the role of the GP, just because ‘that is the way that it has always been done in the past’.
- GPs are nurtured and develop the necessary skills required to be able to manage and adapt to the future landscape of an ever changing NHS.
Many GPs have their own ideas on what the root cause of the problems within primary care are, what actions are necessary so that improvement occurs and what change is required in order to ensure sustainability. ‘General Practice: Forward View’ (NHS England, 2016) is the latest document released outlining change, investment and reform. It seeks to address rising workload pressures and growing patient concerns about access.
To summarise ‘General Practice: Forward View’ focuses on improvement in the following areas:
On investment: by 2020/21 recurrent funding to increase by an estimated £2.4 billion a year, decisively growing the share of spend on general practice services, and coupled with a ‘turnaround’ package of a further £500 million. There will be investment in staff, technology, GP premises, and action will be taken concerning indemnity and growing red tape.
On workforce: attempts will be made to try to double the growth rate in GPs, through new incentives for training, recruitment, retention and return to practice. During the last 10 years there has only been a net increase of around 5,000 full time GPs, however the aim will be to achieve a further 5,000 net in just the next five years. In addition, the aim will be to recruit and train 3,000 new fully funded practice based mental health therapists, an extra 1,500 co-funded practice clinical pharmacists, and nationally funded support for practice nurses, physician assistants, practice managers and receptionists.
On workload: there will be a new practice resilience programme to support struggling practices, changes to streamline the CQC inspection regime, support for GPs suffering from burnout and stress, leadership and management development for GPs, legal limits on administrative burdens at the hospital/GP interface, and action to cut demand on general practice.
On infrastructure: there will be new rules to allow up to 100% reimbursement of premises developments, direct practice investment tech to support better online tools and appointments. Consultations and workload management systems along with better record sharing to support team work across practices.
On care redesign: there will be support for individual practices and for federations and super-partnerships. There will be direct funding for improved in hours and out of hours access, including clinical hubs and reformed urgent care; and a new voluntary contract supporting integrated primary and community health services.
This is a substantial investment and strategy for reform. It represents a significant amount of support and should add a large amount of resilience in to a system that has been under resourced for the last decade. It is aimed as a five year piece of work and within that time period it will be important that the system continues to learn and respond to changes in circumstance, national health and government.
Will this represent the solution to the complex challenge of solving the primary care system crisis?