The end of general practice as we know it
Ben Gowland, former head of Nene CCG and now heading up healthcare change agency Ockham Healthcare, says general practice is in crisis and more money is needed - but the system needs a return for the extra investment.
General practice has not significantly changed in the 67 years of the NHS. So when the ‘general practice needs to change’ brigade come around again, it is easy to understand why the majority of GPs ignore the naysayers and carry on with business as usual.
But this time things really are different. General practice is in its own crisis, alongside, but also separate from, the rest of the NHS. This time general practice cannot continue with its head in the sand because it is doing just fine, thanks. It needs help. And help is not going to come without strings.
No-one questions the vitally important role that general practice plays in our health system. Our system of list-based general practice is the envy of the world.
The critical problem, however, is the fragmentation that exists between general practice and the rest of the health system. And this is a problem both for general practice and for the NHS as a whole.
We have grown up understanding that seeing our GP is different from going to the hospital. We often have one relationship with our GP, and quite another with our consultant or specialist team whose care we are under.
The 5 Year Forward View (5YFV) is important for general practice because it commits to closing the gaps that exist in the system: the gap between primary and secondary care (should I as a patient be the one who has to tell my GP why I was admitted to hospital?), the gap between primary care and community care, and the gap between primary care and social care.
The change that the 5YFV demands, and the strings that are going to come with additional funding for general practice, is the integration of general practice with the rest of the health system.
The biggest signal of this change comes with the selection of sites as ‘Vanguards’ for the Multi-Specialty Community Providers (MCPs), the new accountable care organisation-style model for out of hospital care.
These sites, such as Vitality in Birmingham and Lakeside Health in Northamptonshire, represent the change in general practice to an at-scale offering, that is capable of creating its own efficiencies, of developing and leading its own partnerships, and of making change that will impact upon the system as a whole.
One of the key problems general practice has faced, particularly when it comes to attracting additional funding, has been its inability to deliver change that materially affects the whole system.
A good example of this is that general practice as a provider has no coherent representation within urgent care networks. GPs struggle to represent their own practice, because of the difficulties of ensuring that all the partners within a practice agree - let alone be able to make decisions on behalf of all the practices in an area.
What the new vanguard sites are starting to demonstrate is that this fragmentation is not a necessary feature of general practice, that decisions across a larger area can be made and acted upon, and that a general practice offering at scale can impact on the system as a whole.
This is why these ‘GP Providers’, whether federations or much larger practices with multiple sites, represent the future of general practice. It is not core general practice itself that needs to change. Rather, it is the way that general practice is organised.
General practice is in crisis. More money is needed. But the system needs a return for the extra investment, and this will only come through the development of at scale general practice.
The choice general practice has today is whether to be dragged kicking and screaming into the future by other organisations (acute trusts and the like), or to accept that change is required and become the leaders not only of a new model of general practice, but of whole systems of care.
Ben Gowland was Chief Executive of Nene CCG for nearly eight years. He left in April 2015 to set up Ockham Healthcare, a healthcare management consultancy he describes as a “platform for change”.
Previously Ben was Director of Service Improvement at Croyden NHS Trust and before that a programme director at the Modernisation Agency. Ben hosts RealityBites – The National Healthcare Conversation, a weekly online podcast.
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.
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