A new government must prioritise general practice. Here’s how.

Competition for the attention of the incoming Secretary of State for Health and Social Care will be fierce. Their to-do list – including ‘fix NHS waiting lists’, ‘make the NHS more productive’ and ‘introduce a plan for social care’ – is daunting. Focusing on the acute sector and creating short-term ‘fixes’ for general practice (like access targets) will be tempting. Prioritising deeper, more meaningful action on general practice would be unusual but wise. 

General practice is the foundation of the NHS. GPs are responsible for long-term care of their patients, provide preventative care, and control access to most other NHS services. But general practice in England is in a precarious place. The poor sibling of the acute sector, in the past decade the proportion of NHS funding spent on general practice has declined. The number of full-time equivalent (FTE) qualified GPs has fallen, as demand for appointments has risen. Public satisfaction has plummeted, and GPs feel that the quality of care they provide is declining.  

All major political parties have promised to improve general practice, but detailed plans haven’t yet emerged. With plentiful ground available to cover, where might a new government start?

The proportion of NHS funding spent on general practice must increase

After a decade in which spending on hospitals has outpaced spending on general practice, polling from a partnership between the Health Foundation and Ipsos shows that the public prioritise increasing funding to primary and community care over hospitals. Government should listen to this, and the proportion of NHS funding spent on general practice must increase (a commitment to increase the share of NHS funding to general practice by 1% a year – a mechanism already used to increase primary care spend in other health systems – might be one approach). Any government serious about reducing health inequalities must also fix longstanding disparities between funding of GP surgeries in richer and poorer areas. Finding ways to better tie funding for general practice to desired patient outcomes would reassure ministers that this represents money well spent (the recent consultation on incentive schemes in general practice may help).  

Government must do more to retain GPs – and pay attention to getting the right mix of staff

The NHS Long Term Workforce Plan commits to doubling the number of GP training places by 2031/32. But this won’t be enough to fix the workforce crisis in general practice. Problems with GP retention start early – every two filled GP training posts results in around one fully qualified FTE GP. And the problem continues, with GPs at all career stages cutting back clinical hours in response to difficult conditions and high workloads. 

Alongside acting to curb rising GP workloads, government will need to consider how to better capitalise on the massive expansion of direct patient care staff in general practice (almost 40,000 have been recruited since 2019 from a mix of backgrounds including paramedics, pharmacists, physiotherapists, physician associates and mental health practitioners). Their rapid roll-out boosted appointment numbers but has not resulted in improved patient satisfaction and may have decreased continuity of care, while driving up costs. Studies on changing skills mix in general practice show warning lights that must be taken seriously.

Avoid overly prescriptive new structures

Faced with falling numbers of GP partners, trends towards bigger GP practices, and the ongoing criticism – and defence – of the partnership model, a new government must consider how far it wants to wade into the treacherous ownership debate. The current approach – of allowing different models to emerge – has strengths. Ripping up the partnership model would decimate the GP workforce, and there is no consensus on what could replace it. But letting partnership ‘wither on the vine’ may not be wise either. In some – predominantly poorer areas – surgery closures are making access to general practice all but impossible.  

At the Health Foundation we have previously argued that considering alternatives to the partnership model makes sense, but that form must follow function. In the context of an expanded remit for general practice (since 2019, the introduction of primary care networks has changed the way that care is offered to patients, the role of GPs and the range of services available from GP surgeries), government should make sure it is clear on what general practice is really for. Then, work on designing and supporting organisational forms that meet those functions. 

Pay attention to support infrastructure

Whatever actions a new government prescribes, general practice will need support to evolve. Commissioners with strong local knowledge, trusting relationships and detailed understanding of some of the more esoteric aspects of primary care finance and estates are essential in ensuring that general practice functions effectively. Until integrated care boards (ICBs) replaced them in 2022, clinical commissioning groups played a critical role in supporting general practice. It’s unclear how much of their capacity and expertise has transferred to ICBs. As well as considering what to do on general practice, government must pay attention to how it will be done: support for implementation and transformation in general practice has frequently been overlooked – risking the failure of otherwise well-designed policies. 

Know what not to do

In theory, the model of NHS general practice is a good one. But after a decade of relative under-resourcing, performance is lagging, and patients are suffering. A new Secretary of State must prioritise fixing this. Recognising what not-to-do is important too. Wholesale re-organisation of English general practice – for instance, transferring the management of GP practices to NHS hospitals – is likely to damage and distract. The Secretary of State would be well advised to avoid setting access targets (they often backfire), and to stay clear of damaging rhetoric that has demoralised GPs and fuelled workforce challenges. Instead, government should focus on increasing investment in general practice, boosting the GP workforce with strategies to retain as well as recruit GPs, and supporting practices to improve the availability, quality and coordination of services. These are the foundations needed to steady a wobbling NHS.