What are the challenges facing primary care?

Policies are in place but what will they mean in practice?

General practice, a cornerstone of UK primary care provision, has for many years been frequently referred to as ‘the jewel in the crown’ of the NHS. But now primary care, and general practice in particular, are facing a crisis, with all the major political parties proffering solutions in their manifestos at the last election. Last June Jeremy Hunt, Secretary of State for Health, provided more detail on the planned manifesto commitments, when he announced a ‘new deal’ for GPs. Will the policy work and what will it mean for the NHS? Professor Ian Watt explores the issues…

It remains to be seen whether the initiatives announced will have any impact on the many challenges facing primary care. This depends in part on the extent to which the proposals can be implemented and adequately funded. Good intentions are often not enough. In 2012, for example, the then Secretary of State for Health, Andrew Lansley, pledged to increase GP trainees by 2015, but this has yet to materialise. 

14260114249_9c71c8c137_oSo it is perhaps no surprise that following his announcement of the ‘new deal’, Jeremy Hunt made a speech later in June where he appeared to soften one of his central commitments. He stated that 5,000 new GPs was the “maximum” that was achievable, and that the government would have to be “flexible” about its 5,000 GPs pledge.

In addition to increases in GP numbers, the government has also pledged 5,000 new non-medical primary care staff, including pharmacists, physician associates (1,000 new physician associates working in general practice by 2020), and district nurses. Physician associates are relatively new in UK primary care, and their effectiveness and acceptability in this setting are currently uncertain.

The details of how the various professional groups will work together, and their respective roles and responsibilities in providing accessible, effective and efficient primary care, have yet to be worked through. The role of the GP, which has already changed significantly over the past 50 years, is likely to develop further. Working with a greater array of non-medical health professionals will require GPs to act in a more consultative way, providing oversight and support to the decisions of the other professional groups who will be seeing patients.

GPs will also see their consultations change as their clinical work becomes increasingly focused on patients with multi-morbidity and complex health problems that cannot be addressed by their non-medical colleagues. Such changes will have important implications for the selection, training and retention of GPs.

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Is there anything else that could be done? Well, other than recruiting more staff and spending more money, one option might be to dismantle the NHS commissioning infrastructure. Currently Clinical Commissioning Groups (CCGs), as the major commissioners of healthcare for their local populations, require significant GP time, taking them away from direct patient care.

Whilst one of the original aims of CCGs was to better utilise GP knowledge of their local communities in order to inform commissioning decisions, it is arguable whether this is the most effective use of GP time and skills, given the current workforce problems. However, this was not a suggestion in the Conservative manifesto.