Sharing common Experiences, Challenges and Solutions.

General practice is facing many challenges at the moment. The day to day pressures in the surgery and consulting room are more acute than ever, as relentlessly rising demand combine with critical staffing and recruitment shortfalls to make life very difficult indeed. Aside from highlighting and discussing these vital issues, a more positive outlook is also needed.

Many would say that insufficient resource is a key factor, and there is certainly evidence to support the view that per capita funding has fallen over recent years. But it can also be argued that the model of general practice provision is due for change – that the ‘corner shop’ approach is now outdated and that GPs should be salaried and part of a larger organisation

Certainly there has been a widespread move to create ‘at scale’ general practice in recent years. Most are federations, or loose collaboratives, but large partnerships or limited companies are being formed in many areas as a way of achieving benefits of scale

Sharing experiences to ease uncertainties

The organisation I work for is a (very) large partnership, and I will be sharing our experiences and discussing some of the issues around this in future blogs. We maintain the view that partner-based general practice, in which independent practitioners are free to configure their services to meet the particular needs of their local communities, is an approach that is both sustainable and more than capable of meeting future needs

Others take the view that, in future, most GPs will be part of larger providers, and employed on a salary like their colleagues in other clinical disciplines. Indeed, the new contract offers this opportunity, as part of one of the soon-to-be-formed multi-specialty community provider (MCP) organisations

As GP’s ponder their future, there are many big questions to address. But at a time when the whole of the NHS is facing uncertainty and change, it is difficult to find clear answers. In the last week alone I have heard the following questions debated, sometimes heatedly…

What are the benefits of ‘at scale’ practice for doctors, and for their patients?

Is it possible to retain the much prized local practice autonomy within large GP providers? Indeed, do most doctors still wish to retain this, and the responsibility that goes with it?

Are small practices fit for the future? Can they be sustained and, if they can, how can they play their part in a system of care that will be built around ever closer service integration?

How will GPs, whether in small or large practice, work with the new integrated organisations? If these are to be ‘place based’, as seems likely, then do large partnerships or federations need to be similarly configured?

Finding the answers

The job of finding a solution to the present challenges, which include the thorny issue of money, falls to the 44 Sustainability and Transformation Plan (STP) programmes across England, and doubtless these and other questions will be addressed during this work. But how well are GPs, other than those holding commissioning responsibility, represented in most STP programmes? And how can they influence the large and powerful NHS Trusts who dominate these when they are disparate, and without the infrastructure or resource to organise, meet, and agree a single approach?

In Birmingham and Solihull, we have brought together the large GP providers to form an Alliance that can inform and influence the STP process. Early on, the Alliance has argued strongly that the ‘S’ part of the process is the most urgent, and an essential prerequisite for the ‘T’ that follows if the new integrated organisations are indeed to be based on a foundation of strong and effective general practice

We’re all in it together

While the challenges are great, I am impressed by the energy and enthusiasm for taking these on that many GP colleagues still maintain. The aim of GP View is to provide a platform for sharing views and ideas on all of these topics, and to debate them vigorously. In doing so, we hope to promote the sharing of ideas and experiences between colleagues across the country and to contribute, in a small way, to the development of a stronger voice and a stronger future for general practice

We want to hear all views, from all sides of the debate. We will welcome short articles and opinion pieces from those wishing to write, and we will encourage readers to respond and debate the points made. Finally, in the true spirit of blogging, we will actively seek out and signpost those who are writing elsewhere on relevant topics, so that GP View becomes the ‘go to’ resource for all those passionate about the future of general practice

I look forward to debating with you!

Mark Newbold  (Editor at GP View)

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