Beccy Baird gives her thoughts on the recent GP contract update and what it means for general practice
To say that the journey to the recent GP contract update has not been easy is something of an understatement. The publication of draft specifications before Christmas led to serious concerns about what general practice could reasonably be expected to deliver. The King’s Fund, among many others, raised concerns about the capacity to deliver one of the primary stated aims of the original contract framework, namely to stabilise general practice. We were also concerned that the primary care network model—on which so much has been staked—could be derailed altogether.
This new contract reflects how seriously the national bodies and the government have considered the significant feedback received and the revised proposals have been widely welcomed. The contract represents a step change in recognising the capacity crisis in general practice, bringing in around £1.4 billion of new money into general practice than that envisaged in the original contract framework, and resetting the immediate demands on primary care networks through the service specifications.
The overwhelming feedback received not only from the profession, but from many other commentators, was certainly key in driving these changes. But reading through the contract and associated government announcements, it’s clear that equally, if not more important to the changes and additional investment, was the government’s determination to deliver on its manifesto commitment to improve access for patients by providing 50 million extra appointments. The significant demands set out in the original draft service specifications, particularly in the delivery of care home visits and structured medication reviews, would have reduced overall capacity rather than increase it. The fact that most of the additional roles were only part-funded also risked the money going unspent if PCNs were unwilling or unable to provide the rest of the funding. And a profession so battered by the demands of the contract that they either withdrew support or became overwhelmed by it was hardly likely to deliver the step-change in access demanded by the government.
Improving access is now an explicit expectation. The new contract states that expanding the workforce is the top priority for primary care for three reasons: first to alleviate workload pressures; second to improve patient experience of access and meet the Government’s manifesto commitment, and third to improve quality of care. Investment in the primary care workforce has increased substantially, with extra initiatives and incentives to improve GP recruitment and retention and a commitment to the GP partnership model through ‘golden handshakes’ and money for training in business management.
While there is no target for access included in the contract, it does implement specific recommendations from the ongoing national GP Access Review, including a new national improvement programme to support PCNs in identifying ways to improve access, developing a nationally consistent extended hours offer and expanding digital services. Practices will also be required to contribute to a more robust dataset which will allow activity and availability of appointments to be analysed at a national level, something which is not currently possible and we have been calling for since our 2016 report on demand and activity in general practice. The contract also sets out an intention to develop a new “as close to real time as possible” measure of patient experience nationally from April 2021.
Challenges remain—even if PCNs can find the new staff to recruit, new roles and teams will need time, capacity and support to help them to develop effective ways of teamworking, to say nothing of expanded premises to house them. Delivering robust, timely data on activity and patient experiences poses significant technical and operational challenges to ensure data is of sufficient quality to be useful and comparable.
But the success of this new contract will likely be judged on the ability of general practice to deliver the government’s commitment to improving experience of access, just as much as on the delivery of the ambitions set out in the NHS long term plan. The extent to which this will impact or detract from those other elements is not yet clear, but in my opinion the new contract strikes the right balance between an ambitious vision for the future of general practice and what is achievable in the short term.
Beccy Baird, Senior Fellow, The King’s Fund
Competing interests: None declared