NHS 70 – a pivotal time for general practice?

Amidst all the coverage of NHS 70, a constant theme has been just how much life has changed since the NHS was first established. So much about our lives, as well as our healthcare needs, is radically different, often in ways that could not have been predicted.

However, there is no sense that a period of stability is imminent. There are tensions everywhere, and not just in the clinics and surgeries where service pressures and recruitment difficulties are high and increasing.

The Health and Social Care Act of 2012 feels very outdated now. It legislates for competition, institutional success and a commissioner-led service, while the Forward View-led transformation drive is bringing in an era of collaboration, where system trumps institution, and commissioning and delivery move closer and closer together. These are fundamental tensions that need resolving because the evident dissonance is creating a strong sense of uncertainty and aimlessness in the meantime.

For general practice, there are many questions. What is the future of the partnership model of practice, and what impact will the GP contract overhaul have? Is ‘GP at scale’ the future, and if so, which of the many models fit best with the future needs of the population? Also, how is general practice going to play its part in locally-based integrated provider systems? Are GPs to be ‘integrated’, or will they ‘work with’ the new providers?

Reform is needed so that the major uncertainties can be resolved. Critical strategic changes must be based on a supportive legislative framework, so that local health system development can progress with certainty, and aim towards a clearly defined and shared, endpoint.

This uncertainty is damaging to general practice. Even the (many) positive individuals, who are busy developing new provider approaches, are constrained by the nagging feeling that everything could change again just as their plans come to fruition. Even more importantly, the brightest and best new medical graduates need to be sure that choosing general practice as a career means opting for a pathway that they can recognise, and identify with.

We should not be negative about what the NHS has achieved, and what it has become, in 70 years. There is much to be proud of, and much success to build on. However, it would be remiss of us not to identify that the current lack of vision, and the clear sense that change is needed, and is coming, is a hindrance to those who believe in a strong future for general practice, and who are doing all they can to bring it about.

What better way to celebrate 70 years than to provide the clarity and direction needed so that we can all get on with the things that matter most?

Let me know your thoughts in the comments below!

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