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 is undergoing profound change but much that is valued will remain

In the latest AnswerTime Ben Gowland was surprised at the clear consensus among panel and studio audience of experts when he asked the question ‘What is the future of general practice?’

In the latest Answer Time I posed the question  ‘what is the future of general practice?’ What was probably most startling about the whole discussion was the degree of consensus that existed as to the answer. AnswerTime 3 - The Future of General Practice

So what did we learn? Well first (in case we were in any doubt) the current crisis in general practice is real. Not only is it real, but it is the reason why the changes that are starting to happen now are different. While general practice has been involved in many changes, particularly around commissioning stretching all the way back to GP Fundholding, the panel were adamant that this particular set of changes are going to stick, because of the crisis that general practice now faces.

Second, the clear message was that GP practices must ‘collectivise’. Whether this means forming into federations of practices that work together in a relatively loose structure, or whether it means the development of ‘super-practices’, where several smaller practices come together to form one larger organisation, is less important. What is important is starting to operate at scale. General practice can no longer thrive if it continues to be organised into 8,000 separate organisational entities.

What the panel were keen to stress was that this did not mean the end of named GPs and personal lists. Continuity of care is an essential part of effective general practice. But what the larger organisations can do is offer both continuity of care for those who need it, and at the same time enable rapid access to a GP (not necessarily a specific GP) for those whose main priority is being seen quickly. They also offer the opportunity to provide a wider range of services, because working together practices are able to offer more than they can individually.

Morale amongst GPs is low. Dr Stephen Shortt listed 4 things that GPs want: to be able to do a good job; to be fairly rewarded for the work that they do; quality of the work day; and peer respect. In the current climate, and with the pressures that general practice is experiencing, realistically it is only the new larger organisations that are going to be able to provide this. Patients, Dr Shortt reminded us, are not the enemy, despite how it might seem when a practice feels ‘under siege’.

The third thing we learnt was that collectivising, and creating these larger organisations, is only the first step of the journey. The development of the new models of care, and the implementation of the plans outlined in the 5 Year Forward View, require general practice to partner with other organisations outside of general practice. Multi-specialty community providers (MCPs), a model broadly supported by general practice, also signal the end of general practice operating in isolation.

In the future general practice will become part of organisations that are bigger than general practice. General practice will be one part of the offering of these new organisations. The relationships between the different partners may start off as contractual, but eventually they will form single organisations. This, Dr Gavin Ralston tells us, is the journey that general practice is on.

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