• The NHS must provide clear and consistent information to support patients as active partners in decisions about their healthcare, including knowing where to go to get help.
• Patients and GPs must be equal partners in co-designing care pathways so that they reflect their real experiences and needs and are easier for everyone to navigate. Patients with complex health or communication needs must be equally supported to navigate NHS services and participate as partners in decisions about their care.

2. Every patient should be able to see their GP when they need to

• Governments must set out clear plans to train, employ and retain enough GPs so that patients can access care from their GP when they need it, addressing both the workforce numbers, the employment structures and funding models that determine where and how GP’s can work.
• To make it easier for patients to see a GP who they know and knows them, practices should be resourced to offer continuity of care.

3. Every patient should be able to access their information and track referrals via user-friendly systems

• Patients and GPs must be equal partners in the design of simpler, user-friendly systems which allow patients to see key information about their care, including being able to easily track specialist referrals. This can only be achieved with significant government investment in systems that are easier to use, better connected, and that reduce administrative burden.
• A diverse and representative group of patients must be active and equal partners in the co-production and review of the systems, including those who cannot access online systems to mitigate digital exclusion.

• Digitalisation: may offer convenience – but could risk continuity of care, does not increase supply of appointments with GPs, and risks excluding some patients.
• Community-based care: may increase options available, but dispersion of services across wider geographical areas could pose challenges for some patients and increase risks of fragmentation and burdens of coordination.
• Prevention: important but could add to already-saturated workloads. May also risk becoming task-focused and impersonal, and consume resource for patient-initiated care.

More clarity is needed about what patients can expect and what “good enough” looks like in terms of access, as is careful co-design and evaluation of the detail of the three shifts.

Research has shown that the first port of call for a veteran seeking help will often be the local GP practice. I would like to emphasise to you and your colleagues the significance of the Royal College of General Practitioners Veteran Friendly Accreditation Scheme for primary care, as endorsed by NHS England in alignment with the Armed Forces Covenant. 

The Veteran Friendly Accreditation Scheme shows staff at GP practices how to handle queries from the 2.4 million veterans nationally (+3m dependents) and signpost them to the most appropriate pathway or support group as per the list below:

• Op Restore: The Veterans Physical Health and Wellbeing Service provides specialist care and support to veterans who have physical health problems as a result of their time in the Armed Forces.  https://www.england.nhs.uk/commissioning/commissioned-services/
• Op Courage: The Veterans Mental Health and Wellbeing Service is a dedicated mental health service for individuals leaving the Armed Forces (those within 6 months of leaving the military in England), veterans and reservists.  NHS commissioning » Nationally commissioned services (england.nhs.uk) or mevs.mhm@nhs.net
• Op Nova: Provides one to one non clinical support to veterans who are at risk of being arrested or already have been, are due to leave prison or have been released from prison. Op NOVA | Forces Employment Charity
• Op Community: Provides care navigation and signposting to the wider Armed Forces community with a specific focus on Serving families. www.armedforcesnetwork.org/armed-forces-community/families/single-point-of-contact/
• Op Fortitude: Delivers a centralised referral pathway into veteran supported housing.  www.riverside.org.uk/care-and-support/veterans/opfortitude/
• Op Sterling: Programme to help older LGBT+ veterans, service personnel and their families. www.ageuk.org.uk/our-impact/programmes/how-we-deliver-advice/operation-sterling/
• Veterans Prosthetics Panel (VPP): Funding on a named veteran basis to NHS Disablement Service Centres (DSC) to ensure that veterans who have service attributable limb loss can access high quality prosthetics. www.nhs.uk/nhs-services/armed-forces-community/veterans-service-leavers-non-mobilised-reservists/
• Integrated Personal Commissioning for Veterans Framework (IPC4V):  Delivers a personalised care approach for the small number of Armed Forces personnel who have complex and enduring physical, neurological and mental health conditions that are attributable to injury whilst in Service. www.england.nhs.uk/commissioning/armed-forces/integrated-personal-commissioning-for-veterans-ipc4v/
• Personalised care for veterans.  NHS England and the MOD have published a new personalised care approach for those veterans who have a long-term physical, mental or neurological health condition or disability. www.england.nhs.uk/personalisedcare/ipc-for-veterans/personalised-care-for-veterans/

 There are also the following linked programmes:

• Veteran Aware: Operated by the Veterans Covenant Healthcare Alliance (VCHA) to improve NHS care for the Armed Forces community by supporting trusts, health boards and other providers (Acute, Community and Mental Health) to identify, develop and showcase the best standards of care. https://veteranaware.nhs.uk/
• Step into Health: NHS Employers scheme to facilitate employment for service leavers and their families. https://www.militarystepintohealth.nhs.uk/
• Veteran Friendly Framework: Designed to accredit care homes to improve their awareness of the needs for veterans. https://www.britishlegion.org.uk/get-involved/things-to-do/campaigns-policy-and-research/campaigns/veteran-friendly-framework

Many Veterans are vulnerable and access to these programmes is critical to their safety. Integrated Care Boards will often have Veterans within the Core20plus5 NHS England Health Inequality Improvement framework, designed to reduce healthcare inequalities.

We need:

• more GPs to meet the needs of our patients
• more GP appointments to stop the 8am rush
• more GP Practice Nurses – familiar faces known and trusted by the patients who need them most
• more GP Practice Nurse appointments delivering local joined-up care closer to home in the community
• better continuity of care – by seeing the same clinician, patients can build trust in who delivers their care and receive better customer service.

Major structural and organisational changes have taken place in general practice in England over the past decade,but it’s difficult to get an overall picture because information about different aspects of general practice is dispersed across multiple datasets, explain the researchers.

They therefore combined information from different national data sources to describe changes in the organisational structure, workforce, and appointments provided by different types of staff in English general practice, and to consider the implication of these trends.

They drew on general practice data collected by NHS England, the Office for Health Improvement and Disparities, and the Care Quality Commission, covering periods of between 5 and 10 years from 2013 to 2023.

They found that the numbers of people registered with an NHS general practice in England grew by 11% from 56,042,361 to 62,418, 295 between 2013 and  2023. And the average proportion of patients aged 65 and over rose from just over 16% to 18%.

But the total number of practices fell from 8044 to 6419, equivalent to 178 fewer practices a year and an overall reduction of 20%, while the average practice list size increased by 40% from 6967 to 9724 patients, equivalent to 291 more a year.

The number of large practices with lists exceeding 20,000 patients also rose from 1% (81) of practices in 2013 to 6% (355) in 2023.

Between September 2015 and September 2022, the total number of qualified GPs working in NHS general practice in England rose from 34,474 to 36,492. But after taking working hours into account, the number of those working the equivalent of full time fell from 27,948 to 27,321.

The average number of GPs fell from 0.53 to 0.45 for every 1000 patients, representing a fall of 15%, with the fall significantly steeper among male GPs: 23% vs 4% of female GPs.

College London and the London School of Hygiene & Tropical Medicine (LSHTM). “Therefore there is likely to be a tipping point in the near future where the majority of appointments in English general practice are no longer delivered by GPs.”

• better align capacity with demand
• improve the working environment for staff
• improve patient experience
• build their capability to sustain improvement

Also part of GPIP is a universal offer that every practice in England can access, which includes:

• online resources on modern general practice including ‘how to’ guidance and quick wins
• webinars covering the components of modern general practice and advice on how to make practical changes and improvements in general practice 
• online problem solving sessions where general practice staff can ‘ask an expert’ for help.

Online resources and guidance on modern general practice:

• How to improve care navigation in general practice
• How to align capacity with demand in general practice
• Creating highly usable and accessible GP websites for patients
• GP website benchmarking and improvement tool
• How to improve telephone journeys in general practice
• How to improve care related processes in general practice
• Modern general practice webinars
• Remote versus face-to-face: which to use and when?
• How to conduct written online consultations with patients in primary care
• Principles of safe video consulting in general practice during Covid-19
• Key principles for intimate clinical assessments undertaken remotely in response to COVID-19
• Administrative triage using digital tools in general practice
• Using online consultations in primary care – implementation toolkit 
• 10 top tips for supporting digital inclusion in general practice
• Inclusive access routes to general practice – support for surgery teams
• Primary care improvement community
• Digital primary care community
• National care navigation training for general practice staff
• Demand and capacity webinar sessions for general practices and primary care networks
• Change Model
• Getting started series guides