Hunt’s deal for doctors forces primary care to be top priority

If a GP from 1948 could be transported to 2015 they would find that, while clinical practice has evolved dramatically in the intervening decades, the ownership and business model remain largely the same in many places.

If Simon Stevens and Jeremy Hunt get their way, this will change over the next five years.

‘If a 1948 GP could be transported to 2015 they would find that the business model remain the same’

The health secretary chose to launch his “new deal” for GPs in the Nelson Medical Practice - an impressive new health centre which provides diagnostics and outpatient appointments, as well as GP services - and this provides a clue about the intended direction for primary care.

Similarly, the prime minister’s decision to make his first speech on the NHS since the election at the equally forward looking Vitality Partnership in Birmingham last month tells you everything you need to know about how high a political priority this is.

The reason is clear: voters care about it.

Both Labour and the Tories had eyecatching policies on GP access during the general election, because both hoped to address a perception among voters that it was becoming harder to see a GP.

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Looking to 2020

The new Conservative government is getting started early on having something to boast about on this front come 2020.

Mr Hunt seeks to strike a bargain. He offers an increase in the primary care workforce to address justifiable complaints from GPs that their end of the health system has not had sufficient investment in recent years. This will be expensive. In return, he wants GPs to step up and deliver on his manifesto pledge to provide seven day access to primary care. This will also be expensive.

The government has pledged £8bn in funding growth by 2020, explicitly tying this to delivering the NHS Five Year Forward View. It is now clear that a lot of this money will flow towards primary care. This is a necessary corrective to years of underinvestment, and is consistent with the most distinctive parts of the forward view that imagine a radical reshaping of the sector.

‘Whether that is an answer GPs want to hear remains to be seen’

Mr Hunt’s proposed new deal gives us some idea of how this might play out on the ground. He plans to add 5,000 non-GPs to the workforce - equal to the expansion in GP numbers.

At the same time, the health secretary has pointedly not defined in what kinds of organisations these new staff will work. Seven day services do not necessarily require traditional practices to extend their opening hours - for example, they could be provided, particularly in urban areas, via urgent care centres.

A new cadre of physician associates is planned, along with more nurses and pharmacists. These skilled non-medical professionals could be allowed to take on some roles traditionally only associated with doctors.

This would ease the GP workload and answer some of the concerns we hear from GPs about overwork and burnout. Whether that is an answer they want to hear remains to be seen.

Top of the list

Problematically for everyone, the forward view does not call for seven day working in primary care, and there is no suggestion yet that there is any more money to fund this element of the new deal.

This will force NHS England to decide which elements of the forward view will be prioritised for funding. Mr Hunt has now made it clear that he expects the parts that reform primary care to be top of the list.

‘Problematically for everyone, the forward view does not call for seven day working in primary care’

In the short term that spells even more financial strain for provider trusts, which could be alleviated only by unprecedented efficiency - another favourite theme of Mr Hunt’s.

By 2020, if his plans are not undermined by financial failure elsewhere in the NHS, we might begin to see GPs working as part of a broader non-acute sector, in larger teams, in different settings, and for new employers. All of this would be unrecognisable to our GP from 1948.