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March 2022

Call for general practice reform

A report by the conservative think tank, the Policy Exchange, has called for radical reform of the way that general practice is delivered, with the independent contractor model phased out within a decade.

Recommending that the current five-year General Medical Services contract should be the last, the ‘At your service’ report suggests that GPs could be employed by ‘scaled’ providers such as hospitals and primary care networks. It also calls for a £6bn ‘rescue package’ to buy out GP premises and fund transition to new models over by the mid-2030s.

The report claims there is increasing dissatisfaction with general practice among patients, even though last year’s GP patient satisfaction survey found satisfaction was at its highest level in any of the last three years.

The Policy Exchange report states that continuity of care must be safeguarded: while the ‘episodic’ user may value speed and convenience, continuity of clinician remains important for the ‘continuous’ user with complex, long-term needs. The report says: ‘The ultimate objective should be to achieve frictionless continuity of relationship between a patient and the entire NHS, delivering on a consumer-driven approach.’

Despite all the accusations over the past 2 years about the alleged difficulty in obtaining face-to-face consultations, the report says that there should be new reliance on digital technology – a ‘smart’ first contact primary care navigation programme called ‘NHS Gateway’ should be introduced, through enhancing the NHS App, and incorporating GP practice triage systems and NHS 111.

Policy Exchange also suggests that the Government should also make better use of technology to tackle GP shortages in deprived/under-doctored, areas. ‘Having a remote consultation between a doctor based in Birmingham and patient in rural Essex would become commonplace’, the report says, adding that NHS-trained GPs should be enabled to deliver remote sessions from abroad.

Other recommendations include increased funding for the Additional Roles Reimbursement Scheme (ARRS) which allows for employment of a range of professionals from care co-ordinators to podiatrists – despite a recent King’s Fund report which found that roles are not being integrated into primary care teams effectively and that ‘there is a risk that the scheme will fail to have the intended impact.’

Health and Social Care Secretary Sajid Javid welcomed the report, saying the consistent message from the public was the frustration they experience accessing their GP. ‘Patients spoke to me about feeling bounced around between primary, community and secondary care.

‘This Policy Exchange report offers some credible ideas and insights across digital transformation, workforce and personalising care provision.’

The RCGP has warned against making any ‘wholesale changes’ to the way GP services are delivered without properly piloting and evaluating any such initiatives.


NHS England has announced details of the 2022-23 GP contract – which the BMA claims is being imposed – which will mean that surgery will have to open longer at weekends.

Practices will be required to deliver full services on Saturdays from 9am to 5pm across PCNs, and from October, PCNs will also be expected to provide bookable appointments between 6.30pm and 8pm on weekday evenings. For individual practices, the existing contractual obligation to make at least 25% of appointments available for online booking will change, but further guidance is awaited. There will be no additional indicators in the QOF for 2022-23, and quality improvement modules will include optimising patients’ access to general practice and prescription drug dependency.

The BMA said it has not agreed to the terms set out in the NHSE letter, received only hours before publication, which are due to take effect from 1 April 2022.

Practice Nurse 2022;52(3):6