Five things you need to know about the Policy Exchange report on reforming general practice

A new report from think-tank Policy Exchange details a ‘rescue package’ for general practice – and the wider primary care sector. The authors conclude that “doing nothing cannot be an option”, with the Government committing to reform over the next decade.

In a foreword to the report, Rt Hon Sajid Javid Secretary of State for Health and Social Care writes:

“There is an exciting future for primary and we need to think deeply about how services are designed and planned – not just within general practice, but across pharmacy and dentistry too. To provide a 21st Century offer to patients, we must give the front-line innovators the right tools to evolve to meet the needs of patients in the future.”

Policy Exchange has set out 23 recommendations for reform. Addressing issues around integration, workforce, digital transformation and scaled provision of primary care.

Highlighted below are some of the key proposals:

1. The future model should include high performing and scaled partnerships (trusts, provider collaboratives or large-scale primary care operators) with most GP partners becoming salaried, but while recognising that there will need to be some parachute arrangements to incentivise them into these new roles. This is not a nationalisation of general practice explains the report, “independent provision will continue to play a central role across primary care, but with incentives to work at a greater scale”.

2. General practice should transition to layered at scale working. Achieving this will require the phase-out of the small-scale independent contract model across much of general practice.
3. A move away from the national GMS contract by the mid-2030s and replaced by a new type of contract, with amendments to the NHS constitution.

4. Digital provision will be at the heart of primary care from increasing use of video consultations to the introduction of the ‘NHS Gateway’, a more ‘coherent’ entry point to primary care. Proposals also include a new Digital Health and Care Bill to give patients more access and control over their patient data and to expand its use for clinical research in the NHS.

5. Improving primary care estate to help support the delivery of multi-disciplinary services. Proposals include supporting the gradual release of owner-occupier primary care estate, with liability for these buildings transferring to the new NHS primary care provider body for management. The ambition is for premises to be organised at ‘place’ or ‘system’ level.

Sajid Javid told NHS leaders at the NHS Confed Expo conference that the current primary care model is not working and promised a ‘plan for change’. However there is no indication when this plan may materialise.

Comment

Whilst certain recommendations from Policy Exchange will undoubtedly prove contentious (in particular the suggestion to replace the GMS contract), many build upon work that is already under way. Whether naturally or as a result of mergers, GP providers continue to grow in size and given their membership of Primary Care Networks are moving towards ‘at scale’ working. The current mood music is to accelerate this process. However, it will be a difficult balancing act to capitalise on the benefits of scale working whilst preserving the localised personal care which is a corner stone of general practice.