Reforming general practice: time to increase supply?

19 October 2015

The week before last David Cameron announced the Government is planning to introduce a new GP contract to support the delivery of seven-day GP services. Subsequent commentary has highlighted it will also facilitate GP practices joining together to provide primary care at scale.

The Prime Minister argued the new contract will also “[g]et rid of the box-ticking and the form-filling”. The Government is right to target bureaucracy. Earlier this month, the Primary Care Foundation and NHS Alliance published Making time in general practice which highlights practices waste considerable resource on activities such as reporting requirements and processing information from hospitals.

Bureaucracy is, however, only one part of a wider problem. Too many GPs are spending time on tasks that other people are better placed to take on. The Making time in general practice survey of GPs indicated 16 per cent of consultations “would have been better served by being directed to someone else in the wider primary care team”. Citizens Advice research suggested 19 per cent of GPs time – almost a day a week – is consumed by “non-medical” demand, including relationship and housing problems. The Eighth National GP Worklife Survey, found GPs spend 19 per cent of their time on “indirect patient care”, e.g. referral letters and arranging admissions, and 8 per cent of their time on “administration”, e.g. practice management.

As part of its “new deal” for general practice the Government has pledged to dramatically increase the supply of GPs. From a starting point of approximately 32,000 GPs in England, they aim to increase this by 5,000 by 2020.

This approach suffers from three key limitations. Firstly, unless recruitment from overseas can be stepped up significantly, it’s probably not achievable. The NHS has an annual target of 3,250 trainees entering GP training, which the GP Taskforce showed was consistently missed in the four years prior to 2014. Secondly, it will take quite a long time to achieve impact. Training to become a GP takes three years after medical school and two foundation years. Thirdly, creating additional supply ameliorates the need to think radically about ways of working.

Rather than trying to expand the supply of GPs, the Government should require the NHS to make smarter use of existing GP resource. The NHS cannot afford GPs – who in England made, on average, £90,000 before tax last year – spending time on activities others can do. The NHS should accelerate the roll out of multidisciplinary teams, be prepared to challenge traditional role definitions and look to the potential of technology. While some places are already doing this, change at scale will be vital. If the new GP contract can support this type of innovation, that will be its most vital contribution.

Leo Ewbank, Researcher, Reform

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