Kamila Hawthorne MBE is Chair of Council for the Royal College of General Practitioners and a GP in South Wales
As the Government prepares to unveil its 10-Year Health Plan (10YHP), the Royal College of General Practitioners (RCGP) is calling for a bold vision and an implementation strategy that prioritises improving patient outcomes through a focus on prevention and community-based services.
General practice is the backbone of the NHS, providing essential care to millions of patients every year. However, the sector is facing unprecedented challenges, from workforce shortages (despite newly qualified GPs struggling to find jobs), to inadequate core funding and outdated infrastructure. We’ve seen a mere 150 increase in qualified GPs since 2019, despite the growing demand for services. This is the Government’s best opportunity to take game-changing action.
As Chair of the RCGP, I’m convinced that general practice is the linchpin of a sustainable, high quality and effective healthcare system. It is incredibly concerning to already see speculation that previous commitments to transfer funding to primary and community care might be delayed as part of the 10YHP, therefore we’re once again laying out why general practice must be prioritised if this plan is going to succeed on its aims.
The Government has already set out three key shifts for the plan to turn into reality: from hospital to community, analogue to digital, and sickness to prevention.
The Government has already set out three key shifts for the plan to turn into reality: from hospital to community, analogue to digital, and sickness to prevention. These are laudable goals, but we need to ensure that they’re backed up by a concrete implementation plan with action and investment.
From a primary care perspective, we believe that the measures of success should include improved GP access for patients, continuity of care, integrated care with streamlined patient records between all NHS services, and much more care delivered close to home. This will improve the patient experience of healthcare beyond measure.
Primary care at the heart of neighbourhood services
Without seeing the 10YP, we don’t fully know what is meant by a ‘neighbourhood health service’, but if properly designed with local communities, the concept has a lot of potential. To me, a ‘neighbourhood health service’ that works well would share care across health, social care, voluntary agencies and community services, such as community mental health services, palliative care and social prescribing. There would be specialised teams based in the community, which would look after more complex patients with long-term chronic physical and mental health illnesses, disabilities, and frailty.
GP teams are embedded in their local communities and know what their patients need. Primary care teams need to be properly resourced to take on a leading role in ensuring ‘neighbourhood health services’ are successful. GPs are skilled at leading multidisciplinary teams, treating and supporting patients with complex and multiple conditions, working closely with other community healthcare professionals and specialists where appropriate, as well as local authorities and the voluntary sector, and take pride in ensuring they can get to the root of what their patients really need. But these teams need the time, workforce, space and structural support to work effectively.
Preserving the universal ‘front door’ to the NHS
General practice needs to remain a universal ‘front door’ for patients, so that everyone can access a family GP to help them understand their health, manage a range of both acute and ongoing conditions, and stay well for longer. GPs need to continue to play a key role as ‘conductors of the orchestra’, helping to triage, refer patients to other services when needed, and navigate the healthcare system. GP practices would continue to operate in much the same way to the patients’ view (based on their patient registered lists), even if their back- office functions are being automated or shared across neighbourhoods.
Ensuring the GP voice
As ICBs go through another period of change, it’s crucial that frontline clinicians have a seat at the table when decisions are being made about how care is delivered. General practice staff need to be part of future planning at all levels of the new structures in the NHS, including those serving ‘neighbourhood health services’ (whatever they look like) and any frameworks over and above these. We must ensure that any new structures and commissioning systems for primary and community care are evaluated in real-time, to ensure they’re improving patient care, providing quality, cost-effective services, and identifying any unintended consequences.
Increasing the GP workforce
To deliver the ambitions set out for the 10YHP, we need a significant increase in the number of GPs. This requires building GP training capacity – both the physical space as well as the number of trainers (which are dwindling), creating long-term employment opportunities for newly qualified GPs, and supporting GP retention schemes. We also need to ensure that there are sufficient staff working right across the community, including in areas of deprivation. The forthcoming review of the NHS Long Term Workforce Plan must prioritise general practice and provide a roadmap for growth of key staff including GPs.
Investing in GP infrastructure
Our previous member survey found that 34% of GPs consider their premises unfit for purpose, and 84% said a lack of space limits their ability to take on GP trainees. We need at least £2 billion investment to fix practice buildings and make space for training and hosting new staff. Investment in primary care infrastructure would also facilitate co-location of community and voluntary services with practices, where this works for the local population and services.
Digitally enabling integrated patient care
A shared patient record is crucial for truly integrated working across the NHS and beyond. Patients should be more involved in deciding how they receive care, through an enhanced NHS App that would allow them access to their own records and test results, and the ability to book their appointments. We’ve seen attempts to progress this in the past, but progress has been painfully slow due to the size of the challenge. Dedicated funding, time, and energy are needed to make sure patient record systems work effectively, securely, and safely for staff and patients. Patients should be able to choose the care they need and access information about their care at their fingertips.
Focusing on prevention
With the right resources and enough time with patients, general practice can do much more in both preventing sickness and illnesses getting worse.
GPs understand the health of their local patient populations and the opportunities that could help improve their health. With the right resources and enough time with patients, general practice can do much more in both preventing sickness and illnesses getting worse. To enable a real shift towards prevention, there needs to be a further shift away from targets for NHS activity towards measuring improved local population health outcomes.
Moving more funding into the community
To ‘shift care from hospitals into the community,’ and to achieve what I’ve set out above, a significant uplift in primary care funding is essential. We’ve seen years of underfunding of general practice, which has resulted in a lack of resources and capacity. RCGP is calling for a Primary Care Investment Standard, ensuring that both central government and Integrated Care Boards (ICBs) increase their spending on general practice and primary care each year.
Conclusion
The 10YHP presents a vital and exciting opportunity for the Government to transform the NHS and put patients first. By focusing on general practice, investing in GP workforce and infrastructure, and encouraging an emphasis on prevention, we can deliver a healthcare system that genuinely is fit for the future. The RCGP is committed to working with the Government and other stakeholders to make this vision a reality. Let’s put patients at the heart of the NHS and build a healthcare system that truly serves their needs.
Deputy Editor’s note: This paper summarises the RCGP’s key recommendations to Government and regional decision-makers as they refine details about how the plan will be implemented over the coming months and years. The RCGP’s full detailed response to the Government’s consultation on the Plan in December 2024 can be found here.
Featured photo by Nicholas J Leclercq on Unsplash.
