With an increasing number of GPs leaving clinical practice or working part time, and many practices unable to fill vacant GP posts, hundreds of thousands of patients are being forced to re-register with another practice after their own practice has closed. Plans to increase GP numbers through pulling more graduates into GP training posts and recruiting internationally are making slow progress.
This briefing presents ideas on how general practice can continue to be provided as the shortage of GPs becomes chronic. It combines findings from a workshop with research evidence and specific examples of innovative practice around the country in order to identify generalisable lessons from current innovators and to outline the ways in which national and local policy can support new ways of delivering general practice.
Keep it local
The design and delivery of new forms of general practice should take place at borough and network level so that services can be tailored to local contexts and the needs of practices and local populations.
- Avoid the imposition of detailed national ‘blueprints’ that dictate numbers of staff and types of services to be offered
- Support funding and policy that allows services to develop in response to evidence of local need
- Tolerate variations in pace of change and in the ways services are delivered if this reflects local responses to population health needs.
Invest substantially in change
A significant proportion of the £4.5 billion committed to general practice and primary care by 2020/21 should be set aside and sustained over several years to invest in capital and running costs and staff development. Most important will be:
training for clinicians in new clinical roles; for GPs to supervise and quality assure new clinical roles; for all practice and primary care network staff to understand new ways of working; and for multi-disciplinary teams working across organisational boundaries
technology to support new, more efficient and more convenient forms of service delivery
premises to be developed in order to accommodate new clinical staff and new services
organisational development support for the introduction of a new workforce and new ways of working.
Without this investment, change will be at best slow and difficult to sustain – and at worst will fail.
Maintain realistic expectations about the pace of change that can be expected from a workforce under intense pressure
Time and resources are needed:
to enable staff to learn new skills and develop new working relationships
to develop trust in new ways of working so they become part of routine care
to involve patients, carers and the public in designing new ways of working
to involve patients and carers in developing communications about changes in GP services and how to make best use of them
to increase staff and patient awareness of, and willingness to use, digital delivery of selected GP services.
Ensure that high quality data is generated, collected and analysed
All new initiatives being introduced to redesign general practice are highly dependent on high quality data, which can be used to monitor progress against stated objectives. However, new methodologies will also be needed to evaluate the broader effects of complex changes in service delivery that are constantly adapting in response to new professional roles and other factors.
Rosen R (2019) Delivering general practice with too few GPs. Briefing, Nuffield Trust.