26 May 2015
Michael Dixon’s Three Point Plan
Filed under Dr Michael Dixon
Increasing pressures and demand, with reduced real and relative funding over many years, have left general practice in poor heart. Early retirement of the 27% of GPs over 55, lack of young doctors to fill the insufficient training places, difficulties in recruiting other staff, and some GP practices going out of business altogether, all call for a radical review of general practice – what we expect of it and how we can enable it to deliver what patients and Government want and expect. Below is a practical three point plan to help general practice on its feet and enable GPs to shed the siege mentality, which has been an adaptive response to an increasingly undoable job. It will enable general practice to restore good family medicine and, with the right resources, meet wider aspirations of extended service and access.
- Fund general practice if you want it to do more. General practice has seen a funding drop of 8% in real terms over the past ten years, while the rest of the NHS has seen an 18% increase in funding in real terms. In short, general practice has lost around a quarter of its NHS share of funding over that time. NHS Alliance called last year for general practice’s approximate 8% of funding to be restored to 10 %. This has not happened and meanwhile some GP practices are facing income reduction due to PMS reviews, MPIG adjustment and funding changes. During 2015/2016 no practice should drop its income and NHS England must produce a realistic plan as to how the funding of core general practice can be restored.
- Take the workforce issue seriously. GP numbers are unlikely to increase significantly enough over the next five years. General practice should be supported to employ and train staff that are available – such as nurses, pharmacists, healthcare assistants, social prescribers as appropriate. Every GP practice should be able to apply for part funding and a training grant for these extra staff. The previous 70%/30% re-embursement model regenerated general practice several decades ago. It’s restoration today will require original thinking on a similar scale with imaginative funding streams that stop growing the hospital sector through activity funding and shrinking general practice through capitation based funding.
- Remove the bureaucratic blocks to better patient care as they are unnecessary in a more transparent culture. The welter of extra work in general practice , which has little effect other than increasing time wasting and pressure, should cease. Much of QoF and the DESs should become core funding. Excessive regulation and yearly mandatory training should be lifted. The attraction of general practice used to be its relative autonomy and freedom to innovate. Becoming the whipping boys of every bright new idea has led to a downgrading of GPs from generalist specialists focusing on patients, families and communities to becoming bottom of the medical hierarchy. Reversing this perception will be key to getting 50% of young doctors to want to become GPs.
General practice is at a crossroads. Without a clear and practical implementation plan, the public will lose their family doctors as they know them, and the NHS will become financially unsustainable.
General practice is at a crossroads. Without a clear and practical implementation plan, the public will lose their family doctors as they know them, and the NHS will become financially unsustainable