Primary care

Developing primary care services is fundamental to delivering a number of the government’s election pledges including commitments to train an additional 5,000 GPs by 2020; give all patients access to a GP from 8am to 8pm seven days a week; and guarantee same-day appointments for everyone over 75 who needs them.

Primary care services are fundamental to delivering the new models of care set out in the NHS five year forward view. Indeed, the Secretary of State has identified improving care outside hospital as his top priority.

The government has proposed a ‘new deal’ for GPs which aims to increase capacity by expanding the GP workforce and encourage the development of a seven-day service to improve patient access. This builds on pilot schemes established under the Prime Minister’s Challenge Fund, which are trialling extended opening hours and new ways of delivering services, and the Primary Care Infrastructure Fund, which is paying for improvements in GP premises and IT.

Notwithstanding these commitments, there is evidence of growing pressures on general practice. In many areas, this means GPs are taking the initiative in developing new care models including federations and larger practices. There are also moves to bring about closer integration of practices with hospital and community services in some areas.

New workforce measures

In mid-June Jeremy Hunt announced the first steps of a ’new deal’ for general practice, aimed at improving quality and access through a seven-day GP service. This included a number of actions in relation to workforce.

He has confirmed the government’s commitment to the Conservative Party’s election promise of increasing the NHS workforce by at least 10,000. This will include an estimated 5,000 GPs, as well as more practice nurses and district nurses, physicians’ associates and pharmacists. This will be informed by work being undertaken on workforce mix for Health Education England.

The Secretary of State has also announced that £7.5 million from the Primary Care Infrastructure Fund for this year will be used to provide training and appropriate tools for community pharmacists to support their role in delivering seven-day services.

Steps to increase GP numbers will include: making it compulsory for medical students to spend time in primary care; a national marketing campaign to encourage students to choose general practice; and making it easier for experienced doctors (including those working abroad) to return to general practice. GP recruitment will be focused on the areas with fewest doctors in proportion to their population (NHS England will publish data on clinical staffing levels at every practice to highlight areas of greatest need), including incentives for newly qualified GPs to go where demand is highest by offering an additional year of training and support to develop specific skills.

In addition, pilots already underway for new physicians’ associates will provide 1,000 associates to work in general practice by September 2020.

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Improving infrastructure and reducing bureaucracy 

Alongside steps to increase the primary care workforce, the new deal for GPs announced in mid-June includes a range of measures aimed at supporting primary care.

The government will continue to allocate funding, worth £1 billion over 4 years, through the Primary Care Infrastructure Fund. Established in 2014 under the previous government, the fund aims to accelerate improvements in GP premises and other infrastructure including IT. Approximately £190 million has already been provisionally agreed for investment in premises this year. This follows on from the Prime Minister’s Challenge Fund which has invested £150 million in pilot schemes aimed at improving access to GP services.

The government has also made a commitment to reducing the bureaucratic burden on GPs. NHS England is engaging with GPs and practice members to determine how this burden can be reduced, and the practical tools that could provide support. The work is due to report to government in the autumn.

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