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’.
The RCGP has called for the government to ‘allow GPs time to innovate’. Ben Gowland thinks general practice needs its own programme as part of the New Models of Care programme, one focussed on supporting the implementation of new models of general practice. Without this, he fears, the pace of change will slow across the whole system, not just in general practice.
Some things don’t make sense. Keeping people in hospital overnight so that we can hit the target for discharges before 12 the next day is one. Changing the pension rules so that huge numbers of doctors and nurses retire early when we need them most is another. And now to add to the list we have creating a national programme of support for acute trusts but putting nothing in place for general practice.
It is now clearly established that general practice is in crisis. Increasingly there are stories of general practice providers getting into financial difficulties. Recently a number of practices in North Derbyshire had to be taken over by the hospital in Chesterfield for just this reason. 61 practices in the UK have been forced to close since 2013. The crisis is not on the horizon; it is happening now.
The Five Year Forward View recognises this. It states, ‘Given the pressures they are under, we need a ‘new deal’ for GPs. Over the next five years the NHS will invest more in primary care, while stabilising core funding for general practice nationally over the next two years.’
But given the overall financial pressures that the NHS is under, the support general practice needs is going to be more than simply financial, because there is just not enough money available to reverse the current decline. General practice itself is going to have to change.
General practice recognises this. Practices are getting bigger. Between 2006 and 2013 there was a 76% rise in the number of practices with 10 or more partners. In the recent BMA survey 43% of GPs said their practice had joined a network or a federation. The HSJ recently reported that there was a ‘boom’ in large scale GP provider organisations being set up in recent months.
But no support is being provided nationally to support general practice make this change. So while a new national programme has been set up by the new models of care team to support the horizontal integration of acute trusts (e.g. the development of service franchises or chains of hospital providers), nothing similar is in place for general practice.
This seems like a startling omission. The aim of the new national programme is to support those acute trusts not planning to integrate acute, community and primary care provision, and to support them instead to find a solution by working in partnership with other acute trusts. Surely the exact same support is required for those GP surgeries that are not planning to integrate with acute or community providers, to help them develop effective partnerships with other surgeries?
The RCGP has recently published what it calls, ‘a blueprint for building the new deal for general practice’. It calls for the government to, among other things, ‘allow GPs time to innovate’. I would go one step further. I think general practice needs its own programme, one focussed only on supporting the implementation of new models of general practice, as part of the New Models of Care programme. Without it, it is not just the pace of change in general practice that will not be quick enough, but the pace of change across the whole system.
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