Matt Hancock’s changes to primary care could be the end of NHS general practice as we know it
GPs have worked out how these changes would impact their patients and their worst fears have been realised
The phrases “death knell” and “final nail in coffin” are probably not the descriptors Matt Hancock was hoping GPs would employ when explaining the impact of his NHS long-term plan on primary care. But that’s definitely what it’s being called by some of the 25,000 members of a Facebook group I run called The Political Mess, which campaigns for improved conditions for doctors and our patients.
The plan was first announced by Hancock in early 2019, but most GPs were not consulted at the time, and specifics were fairly thin on the ground, so the “draft service proposals” outlined by NHS England and NHS Improvement before Christmas have been pored over at length. GPs have worked out how these changes would impact their patients, and their worst fears have been realised; this could be the end of general practice as we know it.
Throughout 2019, as instructed by the new plans, GP practices have formed local clusters to create primary care networks to collaborate and share services. This can allow pooling of resources and reduce waste, which in principle is great. One of the key tenets of Matt Hancock’s long-term plans is a focus on prevention rather than cure, picking up on declining health before people become really unwell.
As such, the new plan proposes that care homes are visited by GPs on alternate weeks for meetings to check up on residents. The plan also necessitates meeting patients for medication reviews every six months in addition to regular work. Some GP surgeries cover more care homes than others, but pharmacists and other staff can work between several GP practices, creating shared responsibility throughout the network.
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We know that prevention is better than cure, and if we were living in a world of plenty, these proposals would be sensible, brilliant even. But unfortunately we’re not living in that world; we have the lowest number of GPs per patient in Europe. These new proposals heap extra work on a struggling system. In addition, the plan does incorporate funding for new staff members like pharmacists, but no funding for the GPs taking on the enormous operation of managing these services.
Ambitious plans should have a long lead-in time to allow requisite structures to be built. Imagine that you’re building a tower. You want it to be tall and strong, able to withstand the harshest winters. Hancock is asking us to knock down our existing, fractured structures and build towers like these in their place – GP surgeries which are robust, providing gold-standard care.
But how can we knock down our current structures when we don’t have the man power to build new ones? The rock hasn’t been carefully quarried and the ground isn’t level. We could stick a flag on the top and it might look alright externally, but without deep foundations, these towers will collapse. It takes 10 years to train a GP, many more to gain the skills to run a complex primary care service. We need to train more staff and support the existing ones. A service like the one proposed isn’t built overnight.
What is also clear from the plan is that the care received will be inequitable. Care homes proliferate in areas where buildings are cheap, and people are poor. People in low socioeconomic groups also suffer a far greater burden of disease. GP practices in socially deprived areas therefore have both more care homes, and more sick people on lots of medications. In practice, this means that the plans disproportionately heap pressure on our most deprived communities. The draft proposals need to be reworked to reflect the variations in healthcare need across our nation.
The British Medical Association have just entered into negotiations with NHS England and NHS Improvement. When the plans are finalised, GP practices will choose whether to join the scheme. But if they reject the proposals, it has been made clear that someone else will provide these services for their patients. There is risk involved in devolving responsibility to an unnamed third party to look after patients, and there is concern among doctors that this new system will allow further back-door NHS privatisation.
GPs work on the NHS frontline every day, and desperately want to support positive change after 10 long years of austerity. They want to build services which are robust and efficient, steadfast and safe. In their current state, GPs cannot safely support these “long-term” plans which are being pushed through tomorrow; they fear that if they do, the whole service will crumble.
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