It is good to see that the NHS Long Term Plan1 recognises the importance of general practice and community care. Surely just the phrase, ‘We will boost out-of-hospital care’ must be music to the ears of GPs up and down the country? Right? Maybe.
I do think that the emphasis and focus on services out of hospital is a good thing, but even the above phrase, ‘out-of-hospital care’, seems to define these services in relation to where ‘proper’ care takes place – i.e. in the hospital. My concern is that while the right words might be being said here, they will not turn off the spotlight that is firmly fixed on A&E, and wherever the spotlight shines tends to be where the resources flow to. Those who follow my blogs will know that I have spoken about this before.2
I guess there will be a number of big questions that GPs will have about the Long Term Plan. I would like to consider just one aspect though: the additional resourcing of general practice. One of the things that has bothered me for a while is how, despite it being recognised that general practice needs additional support, any additional funding comes with significant strings attached. I will go further. It seems that people identify a problem that they feel general practice might be able to help with, let’s take A&E attendances as an example, and then follow the thought process I will outline here:
- We are clearly now talking about ‘emergency care’.
- If we want to GPs to do more to address this, let’s fund them to do more emergency, ‘on-the-day’ care.
- Any funding for this then gets tagged with the need for the money to be used to increase capacity for on-the-day appointments.
All makes perfect sense? No!
This kind of thing totally misses the point and demonstrates a lack of understanding about how general practice works. The bottom line is that we need more capacity in general practice, whether this be to ensure adequate numbers of on-the-day appointments or longer slots to properly assess frailty. Practices are able to manage their own demand, and will flex things according to need. It is a nonsense to direct them to increase only one element of the services they provide without taking into consideration the entirety of the services provided.
Can I propose an alternative model?
Why don’t we just give general practice more money?
By all means tell general practice what outcomes you would like to see resulting from the funding, but let’s not pretend we know exactly how all practices need to run things – let’s leave the detail to the practices themselves. Let’s keep the monitoring ‘light touch’ as well, shall we? I appreciate the need for commissioners to know what has happened to their money, but overly burdensome bureaucracy doesn’t help anyone. I suspect most commissioners bear the scars from making this mistake.
My plea from this article is that we value general practice, that we appropriately fund general practice, and that we then allow general practice to deliver. Until that happens, no matter how well written our plans are, they may fail to bring about the benefits and outcomes that we are looking for.
Details of the GP Contract have now been released, which gives some assurance that there will be more resource for general practice, but the devil will be in the detail of what strings might be attached.
Dr Jonathan Griffiths
GP, Chair of NHS Vale Royal CCG
- NHS. NHS Long Term Plan. NHS, January 2019. Available at: www.longtermplan.nhs.uk/
- Drjongriffiths. Blogging about healthcare and the NHS. drjongriffiths.wordpress.com/2018/12/21/a-gp-is-not-just-for-christmas-admission-avoidance (accessed 8 February 2019).