Health and Social Care Select Committee report: The future of general practice (20 October 2022)

Summary

This Health and Social Care Select Committee report examines the pressure currently facing general practice, which is leading to low morale, GPs leaving the profession and problems recruiting new GPs. In turn, patients are increasingly dissatisfied with the level of access they receive. The root cause of the situation is that there are not enough GPs to meet the ever-increasing demands on the service, coupled with patients presenting with increasing complexity due to an ageing population.

The report outlines the Committee's assessment of the key issues, including the problems with reliance on locum doctors and lack of continuity of care, and outlines what the Government should do to equip general practice for the future.

Content

The report covers the following issues:

• Access to general practice
• Continuity of care
• General practice and new NHS organisations
• The GP partnership

It makes the following key recommendations:

• The Government needs to acknowledge that general practice in in crisis and that patient access to a GP is unacceptably poor.
• The Government should commission a review into short-term problems that constrain primary care, including the interface between primary and secondary care, prescribing from signing to dispensing, administrative tasks, day-to-day usability of IT hardware and software and reviewing of bloods, pathology and imaging reports
• The Government should provide funding to create 1,000 additional GP training places per year and consider extending the GP training scheme to four years.
• The Government and NHS England should identify mechanisms to distribute GP trainees more equitably across the country.
• NHS England should set out how it plans to increase the flexibility of the Additional Roles Reimbursement Scheme to allow Primary Care Networks to hire both clinical and non-clinical professionals.
• Given they are often the first point of contact with primary care for most patients, NHS England should review and consider providing standardised national training for receptionists to drive up standards and equip receptionists with the skills required.
• NHS England should take further steps to address the administrative workload in general practice, including by introducing e- prescribing in hospitals and focusing on the primary-secondary care interface by encouraging ICSs to provide a reporting tool for GPs to report inappropriate workload transfer.
• The Government should also fund research into the specific role that machine learning can play in the automation of reporting and coding test results to reduce clinical admin in general practice.
• The Government should undertake a full review of primary care IT systems from the perspective of the clinicians with an emphasis on improving the end user interface.
• NHS England should include a specific focus on encouraging locum GPs back into regular employment by supporting GP practices to offer more flexible working patterns.
• The Government and NHS England should adopt the recommendations related to NHS pensions in our recent Report on Workforce: recruitment, training and retention in health and social care.
• The Government and NHS England must acknowledge the decline in continuity of care in recent years and make it an explicit national priority to reverse this decline. 
• NHS England should introduce a national measure of continuity of care to be reported by all GP practices by 2024. It should also provide Primary Care Networks with additional funding to appoint a ‘continuity lead’ for at least one session per week.
• The Government should examine the possibility of limiting the list size of patients to, for example, 2500 on a list, which would slowly reduce to a figure of around 1850 over five years as more GPs are recruited as planned.
• NHS England should champion the personal list model and re-implement personal lists in the GP contract from 2030 onwards.
• Integrated Care Systems should prioritise simplifying the patient interface with the NHS by improving access, triage and referral across first-contact NHS organisations including general practice.
• NHS England should abolish the Quality and Outcomes Framework and Impact and Investment Framework and re-invest the funding in the core contract, weighted to account for patient demographics including deprivation, to incentivise continuity of care.
• NHS England should revise the Carr-Hill formula to ensure that core funding given to GP practices is better weighted for deprivation.
• The Government and NHS England should increase the level of organisational support provided to GPs with a particular focus on important back-office functions such as HR, data and estates management.
• the Government should reaffirm its commitment to maintaining the GP partnership model and explain how it will take forward our recommendations to better support the partnership model, alongside ongoing work to enable other models of primary care provision.
• The Government should consider adopting the approach to GP premises taken in Scotland and conduct its own analysis of whether this would be viable for general practice in England.
• The Government should accelerate plans to allow GP partners to operate as Limited Liability Partnerships or other similar models which limit the amount of risk to which GP partners are exposed.