Nada Khan is an Exeter-based NIHR Academic Clinical Fellow in general practice and GPST4/registrar, and an Associate Editor at the BJGP. She is on X: @nadafkhan
We are coming up to a UK general election sometime between now and January 2025 and as in previous pre-election years, the RCGP has developed and published an election manifesto. Billed as ‘seven steps to save general practice and safeguard our NHS’, the manifesto, presented by Kamila Hawthorne at the recent RCGP Annual Conference, reflects the policies the RCGP believes political parties need to take on board to ‘save’ general practice ahead of the next general election. The asks are to introduce a national general practice alert system, increase the share of NHS funding to general practice, increase funding to patients in deprived communities, develop a national strategy for GP recruitment and retention schemes, invest in general practice building infrastructure, reduce GP time spent on admin and contractual requirements, and guarantee permanent residence for international medical graduates (IMGs) newly qualifying as GPs.1 There’s certainly a lot to unpick here.
These campaigns can help distil important general practice policy aims into a few themes for politicians to digest…
Some of what’s in this manifesto reflects ongoing campaigning by the RCGP. The RCGP’s existing ‘Fit for the Future’ campaign is a vision for how general practice could look by 2030 with the right staffing levels, reduced unnecessary workload and bureaucracy, an increased allocation of NHS money to general practice and improved infrastructure.2 These campaigns can help distil important general practice policy aims into a few themes for politicians to digest, and certainly some of the RCGP lobbying relating to improvements in pension reform, improvements in IT and flexibility around the Additional Roles Reimbursement Scheme (ARRS) funding have been taken on board by NHS England. But some elements of these campaigns can be slow to get off the mark. This year, despite over a decade of lobbying for improved primary care facilities, the RCGP infrastructure report found that 40% of primary care staff felt that their premises were not fit for purpose mainly due to a lack of physical space and consulting rooms to house GPs and trainees.3 The recent Levelling up and Regeneration Bill includes a plan to support infrastructure including GP surgeries, but as the RCGP infrastructure report showed, even when funding was previously available through the NHS England Estates and Technology Transformation Fund (ETTF), many of those who tried to get funding to upgrade their premises were unsuccessful due to insufficient resources and obstructively bureaucratic application forms.3 Time will tell if more and easily accessible funding will open up as a result of the new legislation.
While the RCGP sets out its goals, the current government has its own opinions about the future of general practice, and a lot of this revolves around ‘recovering’ and prioritising access to primary care. Reflecting this focus, the NHS England recent ‘Delivery plan for recovering access to general practice’ has a strong focus on expanding the role of community pharmacy, building capacity in general practice through continued expansion of the wider multidisciplinary team, and plans to promote GP retention through pension reforms and funding for GP retention schemes.4 Some of the issues in the delivery plan reflect past and the current RCGP lobbying campaigns, including plans to free up GP time to reduce bureaucracy, which was also enshrined in the Department of Health and Social Care’s recent ‘Bureaucracy busting concordat.’5
Perhaps it’s just me, but this RCGP election manifesto doesn’t seem controversial, mostly reflects previous RCGP campaigns, and doesn’t set out anything that seems unreasonable. I am not, however, Wes Streeting, the current Shadow Secretary of State for Health and Social Care, who responded to the RCGP manifesto by suggesting it was ‘completely counter to what GPs and patients need’ and represented a ‘managed decline of general practice’.6 He appeared to be particularly affronted by the plan for an alert system to flag unsafe levels of workload.
I’ve written here previously about safe workloads in general practice and primary care alert systems. The existing Operational Pressures Escalation Levels (OPEL) systems in secondary care mean that at the highest alert levels, certain actions can be put into place to increase capacity and ensure patient safety. Why should primary care be different? And would an alert system really ‘turn away more patients’ as suggested by Streeting? In many respects, this horse has already bolted. The roll out of the General Practice Alert State (GPAS) is already underway and, counter to Wes Streeting’s views, was lauded as an example of good practice in the recent Fuller Stocktake report. An OPEL system in the Humber Coast and Vale ICS was a ‘particularly successful’ model of how CCGs are able to support practices to ‘get ahead of expected demand’ and support capacity issues.7 Part of the reason for having a general practice alert system is to demonstrate where and when there are evolving extreme pressures on general practice. Without the data, we cannot fully understand the problem or figure out solutions to fix it. How localities decide to act on information from alert systems is still up for debate and development, but I doubt it’s going to mean more dangerous care for patients when the priority, as always, is to ensure safe capacity for seeing patients in practice.
Treading carefully and building relationships
…a quick scan of previous RCGP manifestos shows that historically, only two or three manifesto asks were ever properly taken seriously by government and implemented.
The RCGP manifesto is a call for all ‘political parties to wake up’ and ‘invest in practical solutions that will actually work’.8 With election trackers predicting a Labour government, it is time for the RCGP to continue to build relationships with potentially new health ministers and their teams. Wes Streeting, the disruptor who wants to ‘tear up the GP contract’, gave a hint of what Labour are planning in their election campaign manifesto when he spoke at the Labour party conference in October. His speech suggested a shift towards preventative services, hinting towards his own plans for recruitment and bureaucracy busting, saying that ‘primary care will be at the heart of Labour’s plan for the NHS – we’ll train thousands more GPs and cut the red tape that ties up their time.’9
What can we expect to happen as a result of the College’s manifesto demands? As Kamila Hawthorne admitted, a quick scan of previous RCGP manifestos shows that historically, only two or three manifesto asks were ever properly taken seriously by government and implemented. This approach reminds me of a quote widely ascribed to Henry Kissinger that goes something like, ‘Effectiveness at the conference table depends upon overstating one’s demands’. Of this year’s election manifesto, which two or three requests are really worth fighting for? The big ask will be to pick out the important issues to stop the fortress of general practice crumbling, whoever is in power this time around.
- RCGP General Election Manifesto 2023, Available from: https://www.rcgp.org.uk/representing-you/manifesto
- Fit for the Future: a new plan for GPs and their patients: Royal College of General Practitioners; [Available from: https://www.rcgp.org.uk/representing-you/future-of-general-practice#campaign.
- Fit for the Future: Reshaping general practice infrastructure in England. London Royal College of General Practitioners 2023.
- Delivery plan for recovering access to primary care. London: NHS England; 2023.
- Bureaucracy busting concordat: principles to reduce unnecessary bureaucracy and administrative burdens on general practice: Department of Health and Social Care; 2022, Available from: https://www.gov.uk/government/publications/bureaucracy-busting-concordat-principles-to-reduce-unnecessary-bureaucracy-and-administrative-burdens-on-general-practice/bureaucracy-busting-concordat-principles-to-reduce-unnecessary-bureaucracy-and-administrative-burdens-on-general-practice.
- Streeting W. The Royal College of GPs is wrong — Labour can save family doctors. The Times. 2023 20 October 2023;Sect. Red Box.
- Next steps for integrating primary care: Fuller Stocktake report. NHS England; 2022.
- College Chair Kamila Hawthorne addressed members this morning at the RCGP annual conference: Royal College of General Practitioners; 2023, Available from: https://www.rcgp.org.uk/news/2023-annual-conference-chair-speech.
- Wes Streeting’s speech at Labour Conference 2023, Available from: https://labour.org.uk/updates/press-releases/wes-streetings-speech-at-labour-conference/