Drawing on analysis of the latest data on GP services and the results of a separate survey of over 100 influential health and social care leaders, the Nuffield Trust argues that general practice is in need of both more money and significant reform to enable it to meet the challenges set out by NHS England in its recent Five Year Forward View.
The Nuffield Trust’s report ‘Is General Practice in Crisis?’ describes how the number of one-doctor GP practices has halved in seven years, from 1,717 in 2006 to 891 in 2013, whilst the number of practices with ten or more doctors has grown by over 75%. The separate survey of health and social care leaders finds that over three-quarters (77%) of respondents agree that small GP practices are no longer fit for purpose.
The briefing also shows that reported funding for general practice has fallen by almost £300m in a single year, between 2012/13 and 2013/14. The authors argue that general practices will need extra resources and support to link up with each other and find new ways to meet the different needs of their patients.
Working in bigger, better-organised groups can carry the important neighbourhood presence that many GP surgeries have through tough times. But it will need politicians to give GPs time and support as they make the switch to scaled-up general practice fit for the future. Mark Dayan, Policy Officer, Nuffield Trust
The Nuffield Trust report finds that:
- There is evidence of a looming staffing crunch in general practice, with over half of doctors over the age of 50 saying they’ll quit direct patient care in the next five years, a rise of over a third since 2010.
- At the same time, more than 1 in 10 slots of new GP trainees were left unfilled this year and there are increasing numbers of GPs working part-time.
- In the last financial year alone (2013/14), spending on GP services fell by 3.8% or £287m, according to the most recent Department of Health annual report and accounts.
- The briefing notes a ‘worrying’ lack of basic information on numbers of GP consultations, which make it impossible to determine the extra pressures facing GPs However, the report recognises that an ageing population with complex needs is putting general practice under strain.
The survey of health and social care leaders, the second of four being conducted in the run-up to the election, shows that:
- Leaders overwhelmingly recognise the need to move away from the traditional family doctor model: a third of respondents said that general practice is in crisis, and two-thirds said it is in need of reform
- While over half of respondents support more funding, many of them said it should not come without changes to the way general practice operates.
Nigel Edwards, Chief Executive of the Nuffield Trust said:
“There is no doubt that general practice is facing great pressures at the moment. Funding is tight, there is an impending workforce crisis and - perhaps most significantly of all - the needs of patients have changed beyond recognition, as the population lives longer with chronic conditions. As our panel of health and social care leaders recognise, the single-doctor practice is now struggling to deal with these challenges and is looking increasingly inviable. But more money alone isn’t the answer.”
The briefing paper outlines the need for GPs to evolve their practices into ‘super GP practices’ – networks of multiple practices that can pool resources and draw in specialist expertise from other professionals like pharmacists, geriatricians and psychiatrists, while also retaining the benefits of the ‘small and local’ model of the past. The principle of realising the benefits of larger size is backed by 9 in 10 of the Nuffield Trust’s health and social care leaders, who agree that GP practices need to be part of larger groups or federations to meet the needs of the population over the next five years and beyond.
In the words of one panel member:
“The 1930s model of corner shop general practice is no longer fit for purpose. It needs to become much more responsive to its customers’ expectations about access and fully integrated with a community, voluntary and social care team, to provide a complete package of joined-up care”.
Mark Dayan, lead author and Nuffield Trust Policy Officer said:
“Many GPs are already joining up to build successful networks with other healthcare professionals in their area. This doesn’t mean that the familiarity of local practices will be lost or that GPs will vanish from rural areas. Working in bigger, better-organised groups can carry the important neighbourhood presence that many GP surgeries have through tough times. But it will need politicians to give GPs time and support as they make the switch to scaled-up general practice fit for the future.”
The Nuffield Trust briefing sets out four key recommendations for politicians seeking to reform general practice:
- Avoid the temptation to adopt a ‘one size fits all’ model or top down targets: local contracts and incentive schemes led by commissioners should encourage solutions that work for different areas;
- Use the GP contract to encourage practices to join together with other GPs and professionals such as hospital specialists, pharmacists and social care staff;
- Improve the availability of data on patient demand for general practice, which the Nuffield Trust says is inadequate;
- Increase investment for a period of ‘double running’ for a fixed period of time in the next parliament to help GPs design and implement new models of care.
The analysis comes soon after NHS England unveiled its Five Year Forward View, setting out a rethink of the way the NHS operates to meet the needs of a rapidly changing population. According to the Forward View, GPs will need to operate at scale and upskill significantly in the future.