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.

Next steps

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!

Mark Newbold  (Editor at GP View)  mark-newbold

  • Sarah Longland
    Posted at 17:22h, 11 November Reply

    Great article Mark – GPs do need to stop complaining about workload as it’s a sure fire way to get commissioners to seek alternative providers for services. GP has to be instrumental in developing the future services. Do or be done unto is my mantra! (Well one of them anyway!)

  • Mark Newbold
    Posted at 12:38h, 12 November Reply

    Thanks Sarah. all sectors are feeling the pressure at the moment, and you are right that GP’s need to take control of their own destiny and my sense is that many are now doing that. Interestingly, we in Our Health Partnership are beginning to feel more ‘system’ support for doing this too, which is reassuring.

    Many thanks for commenting, Mark

  • Dr Helen j Miller
    Posted at 21:50h, 21 January Reply

    Great article Mark. But who are you Sarah Longland to make such comments.? I am an ex CCG Clinical Chair and now back doing full time GPing and loving it. BUT I am working so hard that I do not have the capacity to input into STPs , please do not criticise as I am at the coal face and trying to do my best for my lovely patients …I care , but do not have the emotional energy to do anything else .

  • Mark Newbold
    Posted at 12:48h, 24 January Reply

    Hi Helen, thanks for commenting. Coming, as I do, from the hospital sector it is evident that it is really difficult for GPs to mobilise and influence the wider system because the direct work pressures mean there is no time for individuals to do it. I think one of the benefits of coming together as large scale GP providers is that ‘headroom’ can be more easily created, through support teams and other means, like it is in hospitals? And it is crucial that GPs do influence, because without GP input healthcare will be the poorer

  • Sarah Longland
    Posted at 13:07h, 24 January Reply

    Helen, I am an experienced senior healthcare manager working every day in frontline general practice so I fully understand the pressure and workload issue. My comment was not intended to offend. I fear a future healthcare system without GP at the table and I see the results of this happening in some areas of the country now. There is strength in numbers but without a single voice representing larger groups of GPs appropriately there will be a lack of shift of funding for essential primary care services. There are organisations like this already who are giving GP a serious voice in the highest of places and the work of these organisations will prove to be beneficial to patients and GP practices alike BUT, in my opinion, we only have a small window of opportunity to get this right.

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