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How might the GP contract reflect the proposals of the Fuller Stocktake and House of Commons Report

The current general practice contract (GMS) runs until 31 March 2024. The Department of Health and Social Care and NHS England seem to feel that a new contract is required, whilst GPs believe that the contract is not fit for purpose, however. Sixteen months is an incredibly abbreviated period to renegotiate such an important cornerstone of the NHS. This is made worse by the apparent instability of both central and local NHS decision makers.

William Greenwood
William Greenwood

There are three key drivers to achieve the type of innovation and transformation:

  • Address what patients want from general practice
  • Describe what the NHS wants from general practice; and
  • Meet the needs that GPs themselves want from the services they can provide

It is clear from the last few years that NHS England do not have a ‘masterplan’ for the future development of general practice. Nor do they have the significant new monies to make all the changes necessary to address all the workload and workforce issues current in the present system. Additionally, NHS England and politicians need to understand that their reliance on quick fixes will not deliver the sort of changes needed to achieve sustainable change and transformation.

GPs deliver their services with two key concepts in mind. They want to provide continuity of care and they want to be their patients advocates; and not integrated care system (ICS) appointed agents to ration care.

To do that general practice needs the core (GMS) contract to be funded to a level that makes it sustainable without being dependent on additional or enhanced service funding. A return to the former ‘Red Book’ way of working where every activity carries a fee and is invoiced may be one way of addressing this. This, however, has budget pressure implications in today’s NHS.

Closing the floodgates of work going into general practice is a priority. The Fuller Report identified that the open-ended nature of the current contract is not sustainable and proposed a way of doing this.

The most recent House of Commons Report contains 17 conclusions and 28 recommendations. Significant among these is the importance of retaining the partnership model for general practice and the benefits of working at scale where this improves patient care and supports the practice as the core ‘unit’ of delivery. NHS England preferred model – primary care networks have been in development for around three years and they have built a huge part of their plans around them.

Trying to remove them would require a significant sacrifice elsewhere. It would be better to make them more workable and productive. This would require NHS commissioners to establish a better description of desired national and local outcomes and operate less bureaucracy around reporting. This may be problematic as there is a clear drive for ICSs a greater element of control of local general practice/ primary care activity and finances. Yet, despite the significant pressures on the GP partnership model the evidence is that this model remains an efficient and effective one for general practice if it is funded and supported to the right level.

The House of Commons Report is currently the best, in depth, and honest review of general practice I have seen in the last 30 years. The government has two months to respond. What will it accept? What will it kick into the long grass. What will it fund?

At a time when more and more practices are considering withdrawing from the PCN network Directed Enhanced Service will they put patient and personal safety before the not inconsiderable funding?

A defining moment for the future of GPs and the NHS.

William Greenwood CEO
Cheshire Local Medical Committee
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Last Updated on 23 November 2022