For one day at least the bombardment of doom is silenced: GP leaders have lined up to say that the NHS England’s GP Forward View is largely what they wanted. (The same can’t be said of GP forums of course, but we know many of them would make a tabloid editor blush. First comment on Pulse at 2:10am, “this at best delays the collapse”. Bless…)
The main reason is the really quite large number of £2.4bn annual extra funding for primary care. Moving money from secondary to primary is the right thing to do, it can achieve more value and as a taxpayer I applaud it. The real question is not the number, but how will it be spent?
By far the largest part is more of the same. More GPs, more practice nurses, clinical pharmacists, mental health workers, and generally more of a primary care team. This could be valuable if they have the right work to do. There’s more for premises and more for pay, which if it goes to the right people, could also be valuable. (They can’t call it pay though, it has to be packaged as resilience, sustainability and funding formula adjustments. What do they take us for?). I’d direct more to GPs and practices in deprived high demand areas, as this chips away at the Inverse Care Law.
But what is the funding for doing things differently? Here’s the rub. The thinking hasn’t really changed, as it’s all about supply, precious little about understanding demand or even learning the basics from recent experiments. There’s £500m for 7 day opening, and GP hubs, which have been evaluated as a hopeless waste of money and 3 times the cost of core GP.
Well, I am grateful that a small fraction at £45m is earmarked for e-consultations, because askmyGP does exactly that. It’s no surprise to see it there, with Director of Primary Care Dr Arvind Madan writing the foreword. (He’s a 10.7% shareholder in Hurley Innovations Ltd, which does that too through eConsult / webGP). There are lines for development and transformation support too: what’s most important is that they are spent on the basis of evidence.
To see the thrust of the document I’ve done a little word count:
Online – 22 times
Scale – 15
Telephone – 10
Continuity – 4
We know that continuity of care is the bedrock of general practice, and all the evidence says it is central both to quality and efficiency. It is harder (not impossible) to achieve in large scale units. With only four mentions, how is it going to be enhanced and measured?
My view on the forward view: be careful what you wish for.
PS: Getting to grips with demand and capacity through Loadmaster, click to join our webinar Unblocking the appointment system tomorrowFriday 1pm.
Last time people wanted to know how they could do their own Loadmaster, and I’ll explain.