House of Commons Health and Social Care Committee. The future of general practice: Government Response to the Committee’s Fourth Report

Summary

The Health and Social Care Select Committee report on the future of general practice examined the pressure currently facing general practice, highlighting the challenges being faced by general practice and provided clear recommendations to respond to them. This document sets out the Government’s reply to each of these recommendations.

Content

Government's response to the recommendations:

1. The Government needs to acknowledge that general practice in in crisis and that patient access to a GP is unacceptably poor. Partially accept.
2. 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. Partially accept.
3. 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. Partially accept.
4. The Government and NHS England should identify mechanisms to distribute GP trainees more equitably across the country. Accept.
5. 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. Partially accept.
6. 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. Accept.
7. The Government and NHS England should explore the possibility of providing an uplift to the Additional Roles Reimbursement Scheme to support non-staff costs such as supervision and training or to provide weighted salaries in areas where the cost of living is high or it is hard to recruit. Partially accept.
8. 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. Partially accept.
9. 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. Partially accept.
10. 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. Partially accept.
11. 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. Partially accept.
12. Urgent work needs to be done to stop a bidding war for the services of locums and establish requirements for a minimum fair share of administrative duties. Do not accept.
13. The Government and NHS England should adopt the recommendations related to NHS pensions in the recent Report on Workforce: recruitment, training and retention in health and social care. Partially accept.
14. 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. Partially accept.
15. 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. Partially accept.
16. NHS England should provide Primary Care Networks with additional funding to appoint a ‘continuity lead’ for at least one session per week, and additional admin staff funding to support the lead in the role. The role of the continuity lead GP would be to support practices within their network to increase the proportion of patients consulting with their named or regular GP, learning from best practice around the country. Do not accept.
17. NHS England should champion the personal list model and re-implement personal lists in the GP contract from 2030 onwards. Do not accept.
18. 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. Do not accept.
19. NHS England should re-implement personal lists in the GP contract from 2030 onwards. Do not accept.
20. 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. Accept.
21. 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. Partially accept.
22. In particular, NHS England should focus on significantly improving the outcomes data provided to GPs by focusing data collection and analytical resource on outcomes measures rather than the process data and reporting required by these micro-incentives. Partially accept.
23. NHS England should support Integrated Care Systems to implement gain sharing so that Primary Care Networks and individual practices that support the reduction of secondary care expenditure, such as through reducing unplanned admissions, are able to share in the financial gains. Partially accept.
24. NHS England should revise the Carr-Hill formula to ensure that core funding given to GP practices is better weighted for deprivation. Partially accept.
25. 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. Accept.
26. 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. Partially accept.
27. 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. Partially accept.
28. 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. Partially accept.