11 Nov What do the published STPs say about the future of General Practice?
The 44 Sustainability and Transformation Plans (STPs) will describe the future shape of health services across England. They are the implementation plans for the Five Year Forward View and therefore general practice will be an integral, if not fundamental, part of these.
The work has (controversially) been conducted out of the public gaze, but we are starting to see publication of the plans now. At the time of writing 9 are available, so plenty more to come. Reading these first publications, we can get an initial idea of the direction of travel.
General practice is certainly part of future planning, and the mantra that ‘if general practice fails, the NHS fails’ is quoted often. Every plan published describes a future that includes general practice – albeit general practice that is more coordinated, more collaborative, and more integrated with other services.
” So far so good, but what practical steps should a local practice be taking to ensure it is able to be a part of this brave new future? On this, the plans are much less clear.
New models of general practice
Unsurprisingly, all of the plans describe a future in which there is greater focus on maintenance of health and wellbeing, with targeted early intervention in the home and other community settings. These plans aspire to create integrated community teams, often based in ‘community hubs’, some of which will include and impact on general practice.
There is acknowledgement that investment will be needed to support proposals for more services to be provided in non-hospital settings, via both enhanced primary care and through new integrated providers. Little detail is published on where the funding will come from. Although, it appears that it will be generated, in part at least, by ambitious efficiency plans across the sector.
” Some GP readers will undoubtedly feel there is insufficient recognition of the current crisis in general practice. It is mentioned, and the twin challenges of ‘workforce and workload’ are certainly acknowledged, but most plans include more on future transformation than on stabilising the present.
The phrase GP ‘at scale’ is used frequently, and there are examples of specific initiatives, but most plans are not explicit about moving general practice into a new organisational model. The plans describe how they see general practice working, particularly in conjunction with other agencies, but not how general practice itself should be configured.
My reading of the situation is that this is all to play for. Detailed planning has not yet been done and will be started in the next phase of the process. GPs can still plan how to be part of the new model community services. This might mean surgeries open more hours, with a greater range of services, more responsive to emergencies and more interlinked with different carers and professionals. Ultimately, leading to an Accountable Care Organisation with responsibility for prevention, wellness management and overall budgets for a defined population.
” It is therefore crucial that GPs are fully involved in the next phase of STP work, as it will involve detailed planning of general practice and related services. Anecdotally, the level of involvement in the work so far seems to vary across the country.
Many will feel the outputs and outcomes envisaged for general practice will be very difficult to achieve without moving towards large scale general practice. Indeed, the published STPs offer more than a nod towards the notion that development funds will be directed at larger groupings that are set up to deliver the ambitious new approaches.
Finally, for those aspiring to lead the new integrated providers, they will almost certainly need to sit within a large organisation that has a governance infrastructure commensurate with the scale of the task. There are many ways of achieving this of course, and we will be discussing these at length on GP View in the coming months!