Is this a turning point for primary care?
Research Manager and Head of Health
It has been a big few days for general practice. With its importance often understated within the NHS, these major announcements — some more positive than others — suggest this could be changing.
This week we have seen:
- Expansion of the Additional Roles Reimbursement Scheme (ARRS) to hire 1,000 more GPs. There has been a 44 per cent decrease in GP vacancies between 2022-23, with the suggestion that some GPs are unable to find roles. This expansion is costing an estimated £82 million.
- A 6 per cent pay rise for salaried GPs. The Government has confirmed it will accept the doctor’s pay review body recommendation.
- A ballot for collective action, which is explicitly not a strike, due to a dispute with the GP contract and the funding allocated to practices. The GP contract includes a 1.9 per cent uplift in overall practice funding, something that 98 per cent of GPs believe is inadequate.
- A letter to GPs from the Secretary of State for Health and Social Care stating that “General Practice sits at the heart of the NHS but has been neglected for too long.”
While these all address slightly different issues, each of these have a similar policy context: a historical lack of funding in primary care and a persistent supply and demand imbalances. They all, however, clearly point to one thing. General practice, and indeed the entire primary care system, is in desperate need of more fundamental reform.
Expanding ARRS and providing a 6 per cent pay rise for salaried GPs are worthy interventions, but they are ultimately short-term fixes to more systemic problems. Primary care staff are working harder than ever while satisfaction with the NHS continues to deteriorate. This suggests that our current model is no longer working, and cannot be fixed by simply increasing the volume of general practice appointments available (which have already been massively expanded).
Improving the primary care workforce should involve reviewing the composition of it — understanding, for example, how many specialist nurses, district nurses, or Health and Wellbeing Coaches we need — rather than just increasing the volume of GPs. Practices need to be properly funded day-to-day, but they also need sufficient capital investment and support from government to, say, upgrade their practice estate or technology to meet modern population needs.
The reality is that primary care is facing a fundamental shift in the nature of demand: it is growing both in volume and in complexity. It needs to be able to provide different types of care for different types of patients, and relentlessly focusing on the GP workforce alone will not fix it. That Labour are continuing to emphasise primary and community care in government as much as they did Opposition is welcome. We must wait to see how bold they are willing to be in seeking to realise their goals.