On Thursday, NHS England announced a multi-billion pound package to alleviate pressure on GP services. The report identifies the huge demand that GPs, who conduct two-thirds of the 370 million appointments delivered in GP surgeries each year, face. What's more, patient needs are getting more complicated as the population ages and increasing numbers of people suffer from long-term conditions.
The proposals, detailed in the General Practice Forward View, show that NHS England is thinking ambitiously to meet demand. It backs a greater use of technology within general practice, including apps connecting patients to their practice, and the ability to book and receive appointments over the internet. Seven-day services are supported, as are extended services, including pharmacy, urgent care and diagnostic services within primary-care centres - with £500 million pledged by 2020-21 to fund this extra capacity. Recent Reform research has shown that these measures could save the NHS billions of pounds each year.
Elsewhere, however, the old-model mindset prevails. This is most clearly seen through the Government's commitment to employ 5,000 more GPs by 2020-21. Experts interviewed the Reform report explained that around half of appointments GPs currently deliver could be dealt with by nurses and other clinicians. The NHS would save over £700 million per year if nurses took the 57 million appointments dealing with minor ailments. The Health Select Committee report into primary care - also published on Thursday - recommends the creation of multi-speciality teams, including physiotherapists, practice nurses, pharmacists, mental-health workers and physician associates. The General Practice Forward View recognises the value of a more diverse workforce, but does not act to change it.
Similarly, the importance of scale - as a means to deliver extra care and extended hours - is also recognised. Yet NHS England fails to set out convincingly how this will be achieved across the country. A new contract is announced to target the 14 multi-speciality community provider (MCP) 'vanguards' that currently offer integrated primary-care services, staffed by a wider range of clinicians. However, contracts will be voluntary and so likely only appealing to current vanguards. With no word on how these large providers might expand across the country, as some want to, there is little sense of how improvement might spread. For all other providers, the same, uncompetitive core contracts that have failed to drive change for over a decade will remain - topped up by extra funding.
Contracts that cover the whole care needs of defined populations should replace the current funding streams. These would accelerate the integration of care so desperately needed across the NHS. Providers would scale-up and be incentivised to deliver care at the most effective moment - avoiding unnecessary treatment, especially in hospitals. These should be competed for every five to 15 years to ensure the most innovative providers are delivering care for patients.
Wholesale reform will only be achieved if new care models are built across the country. The General Practice Forward View sets out some key ingredients for the future of primary care. To achieve these, the Government and NHS England will need to develop a more radical blueprint for change.
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