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Ben was CEO of Nene CCG for 8 yrs. He was a Director of an acute trust and has run national improvement programmes. He is a founding director and Principal Consultant of Ockham Healthcare, which he describes as ‘a platform for change’.

General Practice and The 5 Year Forward View: Where Do You Start?

It’s all very well having vision but could the 5 Year Forward View for the NHS be unachievable without swift and durable solutions to the problems facing general practice today?

In the old joke, the man who stops a local to ask for directions is told “Well, I wouldn’t start from here”. In making any change one is always faced with a choice: do you address the immediate problems that you face today, or do you begin with a vision of tomorrow? The 5 Year Forward View (5YFV), with the development of New Care Models, has gone for the latter of these two options, effectively ignoring the current pressures on general practice whilst envisioning a radical new future.

On 31 July NHS England published ‘New Care Models: Update and Initial Support’ http://bit.ly/1HkBhs9. Here is what it had to say about general practice,

‘Multispecialty community providers (MCPs) will deliver an expanded version of core and enhanced general practice, based on larger, more resilient multi-disciplinary teams and bringing together a broader range of specialist and generalist care… Similarly the primary and acute care systems (PACS) will also deliver an expanded model of core general practice, but will go much further by joining acute hospitals to create a single provider system’.

This is a significant shift away from the more careful language used previously and demonstrates a clear intent to transform general practice from what it is now into something quite different.

Chapter 3 of the 5YFV itself prefaces the new models with the ‘new deal’ for general practice. It says, ‘Given the pressures that GPs are under, this (strengthening primary and out of hospital care) is dependent on several immediate steps to stabilise general practice’. There is, in this, at least an implicit recognition that the new models will only succeed if general practice itself is thriving.

But whatever anyone thinks of the ‘new deal’ it is clear that the difficulties facing general practice today have not been resolved, nor does it appear that they will be resolved any time soon.  Bringing general practice together with other providers to create an expanded model is clearly not in itself the solution to these immediate and pressing problems. But if solutions aren’t found soon any attempt to introduce these new models carries a real risk of failure.

The implementation programme, however, is carrying on regardless. There is no mention in the document of the challenges that general practice is experiencing, or the impact that the ‘new deal’ is or is not having. Rather, it is developing new funding mechanisms for the new models;

‘The MCP model is based on a GP registered list. The structure will build in additional community and mental health services and social care as appropriate, converting these into an amount per patient that can be combined with core general practice funding.’

Ignoring the problems general practice faces today does not make them go away. Putting acute trusts or community trusts in charge of a service that they do not understand is no solution to these problems. In addition to the support general practice needs to prepare for tomorrow it needs support to deal with the real and intractable issues it faces today. Otherwise not only will general practice suffer but the whole five year vision for the NHS may be unachievable.

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