General practice is the NHS’s great strength, which it has to review

Although it will not feel like it to many of the profession, it is reassuring that general practice is spending more time in the spotlight. Reassuring, because reappraising the role of GPs is one of the most fruitful areas the NHS can explore and still one of the most neglected.

‘Away from the shouting match, there is perhaps more thinking going on about general practice than in any time in the last 20 years’

The general practice model is one of great strengths of the NHS, perhaps its greatest strength. Yet partly because of that it is a model that has been subject to too little challenge and change. “It’s not broke, so we don’t have to fix it” has been the mantra of many policymakers. The profession itself has often been content to enjoy the quiet life, viewing the upheavals in secondary care with the interested, but distanced, attitude of a Western TV viewer watching the Arab Spring and its consequences.

But the price of a relatively quiet life has seen general practice exercise little influence over the developing nature of healthcare and, the latest research shows, fail to attract the funding its proponents think it deserves.

Clinical commissioning groups, of course, were meant to shift the balance of influence - and in some areas they will; though in others they are going out of their way to avoid being seen favouring GP providers.

Lasting legacy

Of equal significance is a renewed debate about the role of general practice at a national level. At present there is lot more heat than light − with Jeremy Hunt apparently happy to have his relatively mild remarks about GPs spun as attacks.

‘It is unlikely that extra funds will − or should − arrive without a robust examination of GP quality, organisation and responsibility’

In response the Royal College of GPs has reacted in high dudgeon. The decision by chair-elect Maureen Baker to use her first interview to describe the government’s plans to shore up struggling accident and emergency departments as “voodoo med-economics” shows the popularity and profile of the outspoken incumbent Clare Gerada looks likely to have a long legacy.

But away from the shouting match, there is perhaps more thinking going on about general practice than in any time in the last 20 years.

Dr Baker refers in her interview to the idea of federating GP practices that has been long championed by the RCGP since Steve Field was the chair. It is now gaining currency at NHS England, where deputy medical director Mike Bewick has given the idea his blessing.

Investigation and innovation

Dr Gerada has been asked by NHS England to review primary care across London and is already proposing some ideas as radical as those put forward by Lord Darzi’s 2007 Healthcare for London report − albeit from a very different starting point.

The aforementioned Professor Field, of course, has just been appointed the Care Quality Commission’s first chief inspector of general practice. Given that the variability of GP care has received nothing like the attention devoted to differences in secondary care, his work will prove controversial. But those in the profession who want to raise overall standards should support it.

Least commented on, but with significant potential long term impact, is Monitor’s investigation into “the extent to which commissioning and provision of general practice services is operating in the best interests of patients”. The existing system of independent contractors providing the bulk of primary care is long overdue for examination. Not necessarily because it will be found wanting, but simply because a dispassionate look at its advantages and disadvantages for 21st century patients is needed to inform the debate.

The biggest complaint of GPs at present is that primary care receives too little funding − a case with some substance given the increasing demands the service and the government want them to take on. However, it is unlikely that those extra funds will − or should − arrive without a robust examination of GP quality, organisation and responsibility.