UK Public  service general practice – time for a radical new agenda

 

HubMP2012

FEBRUARY 2, 2025

The Westminster Government has signalled its intention to produce its Ten Year Plan for the NHS in Spring 2025. In response Doctors in Unite have outlined its radical vision of what this future NHS should look like in its recently published document Public Service General Practice.

The NHS does need radical change which addresses both the failures of a dozen years of  financial Austerity and a dysfunctional fascination with the capacity of ‘the market’ and for-profit health care to address our needs. This can be achieved only by a fully funded public health service.

Our health service must provide care in a timely way that responds to the present unacceptable levels of ill-health and which promotes healthy living and well-being.

Public Service General Practice provides a vision of how this can be delivered in a way that is consistent with the founding values of the NHS. It supports the call of General Practitioners Committee (England) for a new GP contract. But this new contract cannot just be about the reform of the independent contractor contract. It must also offer GPs the opportunity to be part of a genuine public service, salaried primary health care team that provides care in a community setting, in line with need and which has a strong focus on promoting public health.

Its key messages are:

Investing in primary care services is cost-effective at a societal level. Worldwide evidence is that the stronger the primary care system, the stronger the overall health system is to improve health outcomes, reduce costs, and maximise equity for the population. The NHS Confederation estimates that for every £1 invested in primary care, at least £14 is delivered in productivity across the working community.

Investment in public health similarly is highly cost-effective. Most health care interventions that improve life expectancy and healthy life expectancy are delivered at community levels with primary care as the crucial partner.

Market failure must be recognised and addressed. The Government role is always one of stewardship of a health system for its population. There are many different models of financing and providing such services globally. In the UK, General Practice is commissioned by the NHS via a variety of contracts. This has inherent risk of market failure, which carries a high price for patients, especially for those with the greatest needs. A national NHS salaried contract must be introduced. It is not sufficient to rely on the independent contractor route to ensure equitable access and quality of care.

Continuity of care: continuity of care must be at least as important a goal as access to care because it reduces mortality and inequalities in health outcomes.

The GP is crucial and not just a cog in the multi-disciplinary primary care team. The role of Specialist Generalist as the clinical leader for the primary care team is fundamentally what makes primary care in the UK so efficient, cost-effective and highly productive. It cannot be fragmented and adequately replaced by transactional encounters with a multitude of professionals. A multidisciplinary team without GP leadership is more expensive and less effective.

A primary care pilot of joint general practice / public health posts should be undertaken.

Resources should be allocated according to need, using more sophisticated methods than the outdated Carr Hill formula to ensure that capacity distribution is planned and not left to the vagaries of the market.

Among its conclusions, the report notes: “Staffing numbers need to increase to both address current pressures and the growing burden of unmet need. This needs to be delivered in new or upgraded facilities which are appropriate to a 21st century primary care team. These facilities should be capable of being community assets where patients can be seen in a comfortable, convenient and timely way. They must be capable of hosting a full range of personal medical and public health provision. In renewing this infrastructure, pro-active priority must be given to where facilities are least fit for purpose. It is also crucial we must avoid repeating the pitfalls of PFI and LIFT which have proved to be totally unfit for purpose.”

The full paper can be downloaded here.

Dr Coral Jones, Chair of Doctors in Unite, said:  “The Labour government has not come up with an effective plan for the NHS which addresses the multiple problems of acute care, ambulance services, community services, mental health nor the inadequacies of social care. 

“So far the pronouncements have been made about reducing waiting times. The plan is to increase the private sector, rather than using money to rebuild a NHS public service which is publicly planned and publicly provided. The Starmer/ Streeting vision is one where the NHS will remain ‘free at the point of use’, but the NHS risks becoming a brand behind which private companies operate for profit, thereby diverting funds from the NHS.”