General Practice Forward View - NHS England

1 General Practice . Forward view . APRIL 2016. #GPforwardview General Practice Forward view Version number: 1. First published: April 2016: Classification: Official Gateway publication reference: 05116. This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. Please contact 0300 311 22 33. or email: General Practice Forward view 3. Contents Introduction: Simon Stevens 4. GP services for the future: Dr Arvind Madan 6. Chapter 1: Investment 10. We will accelerate funding of primary care Chapter 2: Workforce 16. We will expand and support GP and wider primary care staffing Chapter 3: Workload 26. We will reduce Practice burdens and help release time Chapter 4: Practice infrastructure 36. We will develop the primary care estate and invest in better technology Chapter 5: Care redesign 46.

2 We will provide a major programme of improvement support to practices Conclusion 56. #GPforwardview 4. 4 General Practice Forward view Introduction There is arguably no more The strength of British important job in modern General Practice is its Britain than that of the family personal response to a doctor. dedicated patient list; its GPs are by far the largest weakness is its failure to branch of British medicine. A develop consistent systems growing and ageing population, that free up time and with complex multiple health resources to devote to conditions, means that personal On workforce: pulling out all and population-orientated improving care for patients. the stops to try to double the primary care is central to any The current shift towards growth rate in GPs, through country's health system. As a groups of practices working new incentives for training, recent British Medical Journal together offers a major recruitment, retention and return headline put it if General opportunity to tackle the to Practice .

3 Having taken the Practice fails, the whole NHS past 10 years to achieve a net frustrations that so many fails . increase of around 5,000 full people feel in accessing care time equivalent GPs, aiming to So if anyone ten years ago had in General Practice . add a further 5,000 net in just said: Here's what the NHS the next five years. Plus 3,000. should now do - cut the share new fully funded Practice - of funding for primary care and So rather than ignore these real based mental health therapists, grow the number of hospital pressures, the NHS has at last an extra 1,500 co-funded specialists three times faster than begun openly acknowledging Practice clinical pharmacists, GPs , they'd have been laughed them. We need to act. This and nationally funded support out of court. But looking back document sets out exactly for Practice nurses, physician over a decade, that's exactly how.

4 It contains specific, associates, Practice managers what's happened. Which is why practical and funded steps on and receptionists. it's no great surprise that a recent investment, workforce, workload, international survey revealed infrastructure and care redesign. On workload: a new Practice British GPs are under far greater resilience programme to support pressure than their counterparts, On investment: by 2020/21 struggling practices, changes with rising workload matched by recurrent funding to increase by to streamline the Care Quality growing patient concerns about an estimated billion a year, Commission inspection regime, convenient access. decisively growing the share support for GPs suffering of spend on General Practice from burnout and stress, cuts A recent report on GP workload services , and coupled with a in redtape, legal limits on pressures by the Primary Care turnaround' package of a further administrative burdens at the Foundation and NHS Alliance said 500 million.

5 Investments in staff, hospital/GP interface, and action this: technology and premises, and to cut demand on General action on indemnity and redtape. Practice . #GPforwardview General Practice Forward view 5. On infrastructure: new rules to Thanks go to the many GPs, allow up to 100% reimbursement other NHS professionals and of premises developments, direct patient groups who've helped Practice investment tech to shape this urgent to do' list support better online tools and - including particularly our appointment, consultation and partners at the Royal College workload management systems, of General Practitioners, the better record sharing to support British Medical Association's team work across practices. General Practitioners Committee, Department of health , health On care redesign: support Education England , the National for individual practices Association of Primary Care, and for federations and NHS Alliance, the Family Doctors superpartnerships; direct funding Association and in local CCGs for improved in hours and out of and Local Medical Committees hours access, including clinical right across England .

6 Hubs and reformed urgent care;. and a new voluntary contract Looking back over nearly seventy supporting integrated primary years, there have been key and community health services . moments in NHS history when the health service has stepped One of the great strengths of up to support and strengthen General Practice in this country General Practice and wider has been its diversity across primary care. Think: the New geographies and its adaptability Deal for GPs in 1966. Think: over time. So one size will not fit new contractual models in the all when it comes to the future 1990s and 2000s. If properly shape and work of primary care. implemented, the wide-ranging But in the round, this support measures in this document may package is likely to herald a perhaps come to be seen as a triple reinvention' - of the clinical similar inflexion point. model, the career model, and the business model at the heart of But be that as it may, the vital General Practice .

7 In his preface thing is to roll our sleeves up, get to this document Arvind Madan practical, and together begin to describes what this could mean make a tangible difference, now, from the Practice and the patient for practices and for our patients. perspective. Simon Stevens Chief Executive, NHS England #GPforwardview 6. 6 General Practice Forward view GP services for the future: Dr Arvind Madan The public relies on General Running the Practice or having Practice services for the health a meaningful conversation and wellbeing of themselves with staff is relegated to the and their family. It is one of edges of the day. Almost every the great strengths of the Practice is struggling to balance NHS, and is recognised time rising workload within tighter and again in international financial constraints. Add to comparisons. this the strain of recruitment issues and it becomes easy to Over my 20 years as a GP see why morale is so challenged.

8 To the wider sustainability of demand for appointments, and Clinicians increasingly feel unable the NHS. Secondly, there is particularly their complexity, has to provide the care they want acknowledgement of historic increased beyond recognition. to give, and understandable underfunding in General resentment of working under this Practice and the need for this There has been a steady rise pressure is growing. to be reversed. Thirdly, practices in patient expectations, a themselves seem more open to target driven culture and a Yet patients rightly expect and new ways of working than at growing requirement for GPs to deserve high quality care from any time I can recall. As much accommodate work previously a familiar team of healthcare because we want patient care undertaken in hospitals, or in professionals they know to improve, as we recognise our social care.

9 This has resulted and trust. We know these survival depends on it. in unprecedented pressure on relationships rest at the heart practices, which impacts on staff of how every General Practice Most observers now agree that and patients. Small changes functions. They are fundamental the solution lies in a combination in General Practice capacity to what we do, namely person- of investment and reform. have a big impact on demand centred coordinated care of It requires action from NHS. for hospital care, so the need complex physical, mental and England , clinical commissioning to support General Practice in social issues, within the context groups (CCGs), health and care underpinning the whole NHS has of the individual, their families organisations, and practices never been greater. and the wider community. themselves. We know there is no single cause for the issues we However, a typical morning I joined NHS England at the end face, and that no single part of in General Practice currently of last year, in part driven by the system acting in isolation can comprises a long arduous my frustration with how I felt fix it either.

10 We need a concerted struggle through appointments, high quality primary care for approach of initiatives, involving phone calls, repeat prescriptions, patients was being undervalued. all stakeholders, across a number results, letters and home visits. Since starting I have made three of key areas. Before you get time to look observations. Firstly, there is up, much less take a break, a deep-seated recognition of it is the afternoon and you how a strengthened version have to start all over again. of General Practice is essential #GPforwardview General Practice Forward view 7. The General Practice Forward The GP is an expert medical view represents a step change generalist and must be properly in the level of investment and valued as the provider of support for General Practice . holistic, person-centred care It includes help for struggling for undifferentiated illness, practices, plans to reduce across time within a continuous workload, expansion of a wider relationship.