Labour’s first 100 days: what lies in store for general practice?

I’m sure many will have scrutinised the main party manifestos over the last couple of weeks. Those who have will recognise the three big strategic shifts of this new government.

• Moving more care out of hospital into primary and community settings.
• Better utilising technology and data.
• Focussing on prevention to support people to stay well and reduce health inequalities.

With Labour’s promise to improve the provision of primary and community care services, general practice could see changes to the primary care landscape in a number of key areas. Whilst it remains to be seen whether they can deliver on their commitment, they have pledged to:

• Train thousands more GPs and guarantee face to face GP appointments for everyone that wants one.
• Bring back ‘the family doctor’ to ensure people always see the same GP by incentivising GPs.
• Deliver a modern appointment booking systems to end the 8am rush.
• Create a ‘community pharmacist prescribing service’ granting more pharmacists independent prescribing rights where clinically appropriate.
• Allow other professionals, such as opticians, to make direct referrals to specialist services or tests, and expand self-referral routes where appropriate.
• Shift care outside of hospital with a trial a move to a ‘neighbourhood health service (by bringing together existing services such as doctors, district nurses, care workers, physiotherapists, palliative care and mental health specialists under one roof), with more care delivered in local communities, shifting resources to primary care and community settings.
• Return to meeting NHS performance standards, with patients waiting no longer than 18 weeks from referral for consultant-led treatment of non-urgent health conditions.
• Carry out a review of the Additional Roles Reimbursement Scheme (ARRS) which many will say has led to a reduction in the GP workforce with general practice and Primary Care Networks choosing to recruit non medics over GPs given the way funding is directed under the ARRS scheme. Currently GPs are not part of ARRS which has proven a particular source of annoyance. 

The manifesto is light on the planning and funding of these commitments, but given the tone and substance of the commitments it is clear that there remains a desire for a more multi disciplined and integrated approach to the provision of primary care. As part of this, there has been no reference to the removal of Primary Care Networks (PCNs) which in many respects is understandable given the fact that the wider health system has been revised to create integration at system, place and neighbourhood level (with PCNs still seen as the vehicle through which integrated services can be provided at neighbourhood level). As such, at least for the foreseeable future, we can assume with a relative degree of confidence that PCNs will be here to stay. Yes, their contractual and legal form may vary as time marches on but there is no indication that there will a fundamental change in principle upon which they were first formed.