Today, Jeremy Hunt announced a ‘new deal’ for general practice, promising to boost numbers in the workforce and to invest in new services and surgeries. But only if GPs keep their side of the bargain – to provide seven day services and to increase preventive and proactive care. Alongside this will be financial incentives to attract GPs to areas of greatest need.
The extra investment and commitment to more staff will be welcome, but will this ‘new deal’ really deliver the much-needed transformation in primary care?
When the future of primary care is considered, the ‘what’ and the ‘why’ are arguably fairly well understood – the service needs to respond to a broad set of challenges stemming from the financial squeeze and changing demography, including better catering for growing numbers of older and more complex patients in a more cost effective way. There is broad consensus that the ‘corner-shop’ model of general practice is unlikely to deliver this wider vision. Instead, general practice needs to operate within larger units which can benefit from economies of scale, plus greater negotiating and employment power. What has been happening quietly and gradually for over a decade with the merging of practices and the closure of small non-viable practices has now become the formal national direction of travel; with the Five Year Forward View encouraging the creation of larger, more integrated organisations.
Configuring yesterday's services for tomorrow's patient
What is not so well understood is the ‘how’ – how we get from the configuration of services we have now to where we need to be. And – as our recent paper sets out – whilst it is of course important that the national context is appropriate to enable change, any national levers need to be accompanied by practical local support, effective leadership, realistic expectations and sufficient time to deliver.
The latest announcement may go some way to setting the scene for change by addressing the workforce challenge but this is only one part of a large and complex puzzle. What matters now is how the newly recruited staff are trained, deployed and developed; how technological innovations are used to best effect; and how new organisational forms can be established to support service reconfiguration at a local level. Indeed, the Government has previously acknowledged that it cannot prescribe the form of scaled up care and that local approaches need to be allowed to flourish.
New online learning network
To help groups of GPs and other primary care professionals work out how to bring about meaningful change on the ground, the Nuffield Trust is working with the Royal College of General Practitioners (RCGP) to run an online learning network to support GPs in establishing large-scale organisations. Funded by NHS England and targeting newly formed and emerging federations and informal groups of practices, the network will offer a virtual platform for GPs to access expert advice, peer support and discussion forums.
The network will seek to disseminate learning and experience to those grappling with the same issues, becoming a repository of useful tips about how (or how not) to do things. By providing a place for sharing, the RCGP and Nuffield Trust hope to offer those who are working to bring about change in general practice a source of support. To help inform the content of this network, we are inviting GPs and CCGs to complete a short survey. If you’re interested in participating in this survey, please email Natasha Curry.
The virtual network is just one strand of a wider programme of work around primary care being developed by the Nuffield Trust. Our network of established GP organisations has been up and running for 9 months and is proving to be a fascinating source of intelligence about the challenges and issues facing general practice. It has also highlighted that there is a huge amount of innovation taking place across the country. Alongside the learning network, our two year in-depth research programme is seeking to understand whether large-scale GP organisations are different to ‘traditional’ primary care in terms of the quality of care they offer, the level of staff and patient experience they deliver and the scope of services they provide.
As we embark upon the research unsure of what we may find, one thing is certain: the landscape of general practice and primary care is shifting and real change has to happen at a local level, driven by the people we need to be invested in it. While changes to the backdrop attract much attention, we should all be keeping our eye on front of stage, where the real action is happening.
About the project
The Nuffield Trust is working with the RCGP to launch a virtual learning network to support practices in coming together in larger organisations. Funded by NHS England, the network will contain a range of resources and case studies for those seeking to come together in networks and federations. As GPs, CCGs and other primary care professionals across the country grapple with the same issues and challenges, this network will spread learning and experience. Free for all those working in primary care to join, the network will launch in Autumn 2015. For more information please email firstname.lastname@example.org.
Curry N (2015) ‘Setting the scene for a new era in general practice?’. Nuffield Trust comment, 19 June 2015. https://www.nuffieldtrust.org.uk/news-item/setting-the-scene-for-a-new-era-in-general-practice