General practice will make or break the 10 Year Health Plan

Kamila Hawthorne, Chair of the Royal College of General Practitioners, has written the following op-ed for GPonline summarising the College’s response to the Government’s 10 Year Health Plan consultation. The full organisational submission can be viewed here (PDF file, 460 KB).  

GP teams delivered a record breaking 40 million appointments last month, a figure that is even more impressive when you consider the pressures we're under. 

There are promising signs that change is on the horizon – we heard over the weekend that Wes Streeting, the Health Secretary, has pledged to review the NHS Long-Term Workforce Plan to train thousands more GPs. This is what the College called for in an open letter signed by nearly 10,000 members, pointing out that current projections would increase hospital consultants by 49%, but fully-qualified GPs by just 4% by 2037.

But whilst greater focus on general practice in the LTWP is encouraging and necessary to rectify this disparity, we will also need to see far greater focus on retention, which the current iteration is greatly lacking. 

And whilst workforce will be absolutely key to securing a robust future for the NHS, we need to see reform in many areas of the health service.

The Government is currently developing the forthcoming 10 Year Health Plan. We submitted our College response to the consultation (PDF file, 460 KB) last week and have been clear resourcing general practice - the front door of the health service, delivering the vast majority of NHS patient contacts - must be its focus.

Our submission draws from the experiences of frontline GPs from member-focused workshops, a call-out for examples of best practice, our RCGP Manifesto asks and a roundtable with major health bodies and patient organisations.

It’s a clear action plan, detailing how and why GPs are a key asset for improving the NHS, where good work is already being done, where we need support to help patients and safeguard the profession, and how we can ensure we're not only recruiting more GPs but retaining them too. 

The Government’s first key policy shift is moving more care from hospitals to communities.

Delivering care embedded in local communities is what GPs and our teams do, so we should be the core of aspirations for a ‘neighbourhood health service’. Many practices already have a successful track record of building networks, we're connected with the wider primary healthcare team and many practices are already integrated with social care, citizens advice, benefits and voluntary services including social prescribing.

We need to make sure that a 'neighbourhood health service' retains the connection to local communities and the relationships GPs have with their patients This means the service cannot operate at too large a scale. Instead, we would like to see it based around existing Primary Care Network footprints of 30-50,000 patients, with practices retaining their existing patient lists and locations.

However, if we're to provide more community care, building on the existing GP framework, we need to recognise the barriers that could hold us back. The proportion of NHS funding spent in general practice has declined in recent years, we urgently need to see resources as well as care shifted into the community. The College is calling for a duty for the Government and local Integrated Care Systems to have to report on this percentage and be held to account for making sure it increases.

Premises are another big factor with 34% of GPs reporting that their practice building is not fit for purpose and 60% saying they don't have enough space to accommodate new MDT staff.

If we're going to be able to better integrate with other services in our neighbourhoods and train the number of new doctors coming through, we'll need significant infrastructure investment to accommodate both patients and staff and allow our premises to house a greater range of appropriate services.

The second policy shift is ’analogue to digital’.

General practice is already a digital service. We're triaging digitally to keep up with the growing workload but also to ensure we’re offering patients the type of appointment that’s right for them.

Many innovative practices are exploring the ways digital technologies can be used to reduce administrative burdens and improve patient experience - we're by no means stuck in the dark ages.

However, the quality of basic IT in general practice as well as interoperability with other parts of the system are serious issues. 30% of GPs say that their computer software is not fit for purpose and 40% say the same of their Wi-Fi quality or speed. Our computer systems struggle to communicate with those in other branches of the health service. 55% of GPs report that their IT systems are not fit for purpose in terms of effectively exchanging information with secondary care.

What we need to see is resourcing replace outdated IT to allow for seamless integration with secondary care and other services; as well as training and resourcing to help GPs use the full potential of modern technologies in a safe manner.

The final policy shift is ‘sickness to prevention’ - prevention for health also being a clinical priority for the College.

An integral part of the holistic care we're trained to deliver is prevention-focused, identifying potential symptoms and issues that risk getting worse.

But it takes time to properly design preventative services, and train teams to deliver them. We will need to work closely with colleagues across public health and community health teams; and our own patient consultations will need to be longer.

We also know that those in the most socio-economically deprived areas are the most in need of support. By reviewing the current funding formula for general practice to channel funds to areas of greatest need, we can support those patients to remain well for longer.

The 10 Year Health Plan could solve many of the major problems affecting the NHS but it must prioritise general practice if it is going to work. As the Darzi Report made clear, the NHS is in a critical condition, but the vital signs are strong.

If we're to bring it back to health, the Government must heed the insight of those on the frontline. We need to recruit many more new GPs - as pledged by the Health Secretary - but we also need to improve the working situation for those already in the profession, delivering patient care, so that they stay in the NHS longer.

Further information

RCGP press office: 0203 188 7659
press@rcgp.org.uk

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.