Why the message of the GP Forward View may not be getting through

9 June 2017

By David Colin-Thomé

General practice over the last few years, despite continuing to provide over 80% of all the clinical consultations in the NHS, has seen its workload hugely increased and its actual share of NHS finances reduced. Announcing the GP Forward View in 2016, Simon Stevens, chief executive since April 2014 of NHS England, said he was “openly acknowledging” the problems and acting on them.
 
We have a GP service which optimally needs to deliver on first point of contact care, continuous person and family focused care, care for all common health needs, management of chronic disease, referral and coordination of specialist care, care of the health of the population as well as the individual (Chambers and Colin-Thomé: Doctors Managing in Primary Care – International Focus 2008).
 
General practice is commendably still the most popular and the clinical service most highly ranked by the Care Quality Commission. This is despite increasing pressure and stresses that threaten its sustainability.
 
All practices small or large, rural or urban, successful or vulnerable need to deliver on that range of services. They may deliver by working either singly or by cooperating with other practices.
 
If a multi-practice, each practice may by agreement only deliver some of these services themselves, with the proviso their patients will receive the full range facilitated or provided by the larger organisation.
 
The current programme to introduce pharmacists into general practice to help with the increasingly pressurised service, needs similarly to be cognisant of local needs and match them with pharmacists with the appropriate skill to meet those needs. It may be appropriate for the pharmacist to be employed at the larger GP organisation level and make them available for individual practices.
 
Other staff needed in general practice, such as physiotherapists, could be similarly employed. Variation in funding to and by practices will need to be decided locally. The role of the larger GP organisation has become enormously significant in the modern context.
 
General medical practice’s heritage, strength and popularity with its patients have been earned by being local to its community and offering continuity of care. These virtues must be preserved and to fulfil the potential of general practice as a local provider and as a service that can shape and transform the NHS, it must be concomitantly small and large – small as an essential element of local social capital and large to be of strategic importance. The ongoing relationship between the practice and the larger GP or broader primary care organisation is fundamental.
 
NHS England is completely committed to major support for general practice but to avoid confusion, duplication and yet enhance support, a rationalisation of various national programmes is essential.
 
Within the umbrella of the GP Forward View, there are numerous programmes, some like those for access, vulnerable practices and resilience, confusingly overlapping and others (like the clinical pharmacists programme) addressing discrete issues of workforce and organisation.
 
The aims of these programmes are all worthwhile and pulling in broadly the same direction, but the existence of multiple programmes with separate funding arrangements is likely to induce piecemeal and siloed working.
 
How do these services aimed at individual practices relate to the larger organisations to which an estimated three-quarters of English general practices belong?
 
GP federations and the primary care home sites see developing, enthusing and enhancing local general practice as an essential part of their broader provider responsibility. Could these larger organisations be the optimal focus for GP support and where all support programmes are synergised?
 
There is an apparent disconnect between the vision and operational reality of the GP Forward View, which was expressed in recent complaints by GP professional bodies that funding does not appear to be reaching the service.
 
This is a pity because the GP Forward View promotes a vision many GPs would sign up to: individual practice working as part of a larger local organisation – a partnership of two equals. Both clinically led, population responsible, patient and community focused but with differing attributes that together can greatly enhance the offer to patients, public and the NHS.
 
Professor David Colin-Thomé is chair of PCC, a former national director of primary care with the Department of Health and honorary visiting professor at Manchester Business School.

For information about PCC’s support for primary care development, contact enquiries@pcc-cic.org.uk

 
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