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General practice forward view reflections

Mark Spencer, co-chair of the New NHS Alliance, gives his thoughts on NHS England’s recent General Practice Forward View.

If there’s one word that sums up my reflections on the General Practice Forward View (GPFV) publication, it’s “hope”. 

General practice is well into its eleventh hour. We are on the edge of that cliff. Drinks are being taken at the last chance saloon. Morale is at an all-time low, workload is at an all-time high. Experienced GPs and nurses are voting with their feet and leaving the profession in their droves. 

The job I’m being asked to do now is not the vocation I signed up for 25 years ago. I am one of the many that are just about clinging on to the hope that things will get better. 

I genuinely believe that the GPFV gives us that hope. Investment in general practice and primary care is vital if we want to keep people out of hospital as much as possible. The planned increased funding is, therefore, very welcome. However, it is unclear where that money will come from. Only time will tell whether it will actually arrive, without any associated increases in workload attached, or if it will actually be spent in the places where it is most needed. 

Not all about money 

It’s not all about money though; importantly it is about general practice staffing. The GPFV recognises that general practice is not just about GPs, but also about the whole of the general practice workforce, including non-clinicians. I was pleased to see that there are many positive elements to recruit, retain, educate, and develop both clinical and non-clinical staff in the GPFV. These include the national development programme for practice managers, and the training and development of practice nurses. More clinical pharmacists into general practice and more primary care mental health staff are very welcome additions to the Primary Health Care Team. 

However while the GPFV goes some way towards a multi disciplinary approach, it lacks a focus on cross-sector working. We already know that we can prevent poor health, and promote health creation when providers of care work together. It is crucial that we modernise and connect with partners beyond the parameters of the NHS, including housing and local government. 

Clarification still needed 

Some major issues still require detailed clarification. At a time when complaints and medico-legal issues are at an all-time high, I would have liked to have seen a detailed proposal covering indemnity. It remains one of the major factors in the decision of many GPs to leave the profession. The GPFV does not go far enough to support the individual GP who faces increasing indemnity costs, especially those wanting to work in high clinical risk areas such as urgent care. We need experienced GPs to take up those posts. A no-risk, litigation averse workforce will merely perpetuate the model of 999 ambulances and hospitalisation for all bar the most minor of ailments. 

Also, I believe that the GPFV does not go far enough to address the severe pressures felt by frontline staff working in our most deprived communities, where the need and demand for primary care access is at its highest. It is time that we moved away from concentrating on the elderly and recognised the impact of poverty on primary care. 

Whilst the funding will help many practices over time, I worry that it will be too little too late for the practices in areas of high demand due to high deprivation and health inequalities. We should be outraged at the levels of health inequality in our society, and these practices desperately need a review of the funding now. 

I do see hope for my profession. I see hope that doctors in training and current medical students will now again view becoming a GP as a worthy, life-long vocation, as I did some 25 years ago. I see hope that nurses, practice managers, and the whole of the multi disciplinary team will be energised and invigorated when they read of the planned changes. 

I hope that it all becomes a reality.

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