The new GP contract is but a small step towards a better future for primary care

Reading some of this morning’s newspaper reports, you could be forgiven for thinking that the new GP contract will – at a stroke – finally return family doctors to their true vocation, remedying the ills visited on the NHS by Labour’s 2004 contract.

The truth is more prosaic. In the absence of additional funding, the government and the BMA have agreed to use existing resources differently. Both sides can fairly claim to have gained something from the deal, which is likely to have been imposed by the government even if the BMA had chosen to reject it.

The main gain for the government is agreement that named GPs will take on accountability for patients over the age of 75. The main gain for the BMA is a substantial reduction in the size of the Quality and Outcomes Framework, reflecting concerns that the professionalism of GPs has been undermined by a ‘tick box’ approach, and representing a reversal of changes imposed by ministers in last year’s contract. The new contract also includes funding to pay GPs for work that will hopefully avoid patients being admitted to hospital inappropriately.

These are sensible changes that go some way towards addressing concerns about workload pressures in general practice and the lack of continuity of care for older patients. But it would be wrong to exaggerate their impact. Much more fundamental changes are needed to meet the needs of older people, as well as those who experience difficulty in accessing GPs in ways and at times convenient to them.

Making these changes depends partly on reversing the reduction in the share of the budget allocated to primary care in recent years. It also means tackling wide variations in the quality of general practice, summarised in the Fund’s major review published in 2011. Equally important is to move beyond the current fragmented model of care to one in which practices collaborate in federations or networks to raise standards across the board and provide rapid access to a wider range of services.

In work with the Nuffield Trust earlier this year, the Fund called for a national framework for primary care to be developed by NHS England with full involvement of the Royal College of General Practitioners, patient organisations and others with expertise to offer. In our view, such a framework is less about preparing a blueprint for the future than setting out what we called ‘design principles’ to support the emergence of new models of care.

Examples of these principles include:

  • a senior clinician available to patients as soon as possible
  • telephones and email used to enable patients to access advice
  • proactive and population-based care, especially for people with long-term conditions
  • care delivered by a team making use of the skills of all team members
  • patients supported to manage their own care where they wish to do so.

Turning these principles into practice means learning from innovations in care underway in parts of the country where GPs and their colleagues are already illustrating what can be done within the confines of current budgets and systems. It also means being willing to learn from experience in other countries where the redesign of primary care has reduced burnout among family doctors and improved patient experience. The example of Group Health in Seattle, showcased at our primary care conference in September, is one inspiring example.

To make these points is to put today’s news into perspective. The new contract reflects the new realism in the NHS with small changes receiving a lot of attention because big changes are either unaffordable or unachievable. The agreement between the government and the BMA is a small step in the right direction, but it falls far short of the rebirth of general practice. Much more needs to be done to transform primary care and ensure it meets the needs of patients and populations in future. 

This blog also features on the Public Finance website.

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Comments

#41064 Azeem Majeed
Professor of Primary Care
Imperial College London

At this stage, it's too early to know how well the GP contract will work and what 'unintended' as well as intended consequences it will have. For example, reducing the size of the Quality & Outcomes Framework may not have a dramatic effect on GP workload if the monitoring of patients will still have to be carried out. It's also unclear how well the 'named' GP concept will work given that so many GPs are part-time.

Prof. Azeem Majeed, @Azeem_Majeed

#41069 Vetri Velamail
Retired full time GP

The named clinician will cause problems with a popular part-time GP, a GP retainer and annual or sick leave. Every time a new government comes in, they have a go at reforming the NHS. The main problem at the moment is understaffing. The DoH will say that there are more nurses than ever before etc. but everyone on the shop floor knows why the NHS is having problems. I'm glad I have retired. Not only was I a full time GP but I also worked for private out of hours provider, covering all the GPs in 3 areas of South Yorkshire who didn't want to work in the evenings. Some of us were putting our lives at risk on these visits.

#41136 matthew ellis
consultant community paediatrician
North Bristol NHS Trust

There are parallels between care of the elderly and care of the neurodevelopmentally impaired child. Both are dependent on carers, have needs that cry out for better integration of health and social care and require an informed professional care coordinator. Community paediatricians evolved to play this role for children and named GPs sound like they will be taking on this role for the frail elderly. In my experience six monthly team around the child meeting with family and concerned professionals to consider where are we know, what are the priorities for the next six months and an action plan go some way to reduce uncertaintly, marshall scarce resources and keep everybody on board a community based model of care.

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