Historic GP ‘partner model’ should be phased out in England to tackle workforce crisis, provide better care and ‘let doctors be doctors’
A new IPPR report calls for general practitioners in England to become salaried employees of the NHS, rather than independent contractors, known as partners, who run their own GP practices. This move would overturn the historic model of general practice that has been in place since 1948.
The think tank’s researchers argue that this shift, to be phased in, would enable the NHS to deliver better access to and quality of primary care in the community. It would also help to address the workforce crisis in general practice, they say.
The report argues that this will be crucial to delivering some of the government’s manifesto priorities. These include delivering 50 million more GP appointments a year in England; raising GP numbers by the equivalent of 6,000 full-time doctors; and boosting morale amongst health and care staff through more professional training and supportive management.
The think tank’s call comes as new IPPR/Savanta-ComRes polling reveals the scale of the crisis:
Across England 36 per cent of people said they waited more than a week for their most recent GP appointment (compared to 28 per cent in Scotland).
Some 3 per cent of people – equivalent to 1.7 million across the country – said they were unable to access any suitable appointment last time they tried to book one.
Patients with long-term health conditions are unable to access important care, according to polling across Great Britain, with over 50 per cent not receiving any kind of basic support – including education about their condition, a social prescription or a longer appointment.
Fewer than one in six such patients reported being given a personalised care plan – a low-cost but crucial intervention that can significantly improve health outcomes.
IPPR analysis also reveals that the steady move by GPs to more part-time work means that since 2014, the NHS in England has lost the equivalent of 3,000 full-time family doctors, 7 per cent of the total GP workforce.
The report argues that the workforce crisis in primary care in England is deeper than is generally understood. The population is ageing, with those over 65 and likely to have more complex health needs now outnumbering those under 16 for the first time in recent history. Yet the number of practising GPs per 100,000 people is now at its lowest since 2003.
This is dented further by the move to part-time working, blamed by many on the workload pressures on GPs.
The government has committed to recruiting a further 6,000 GPs during the current parliament – 3,000 already qualified and 3,000 trainees. However, IPPR researchers caution that a similar recruitment drive over the past five years has failed to deliver the hoped-for numbers.
The report examines what might have happened had the trend in GP recruitment in England between 1970 and 2010 continued. In order to return to that trend, the government would need to recruit some 7,000 fully qualified GPs by 2025 – 4,000 more than the manifesto pledge.
Addressing these issues will require a shift away from the current system of small, local independent GP surgeries, which requires some doctors, known as partners, to take on management and administrative duties on top of their health care duties, says the report.
A new model – Neighbourhood Care Providers
The NHS in England should phase out the current model and introduce new NHS “Neighbourhood Care Providers” (NCPs) with GPs working directly for the NHS, not as independent contractors, the report says.
These new NCPs would serve communities of between 50,000-100,000 people. They would join up primary, community and mental health care and give patients access to longer opening hours, diagnostics and treatment in the community – with a wider team of healthcare professionals such as pharmacists and mental health nurses to support the GPs delivery of care.
These proposals are popular with the public: new polling for the report shows that four times as many people support GPs being employed by the NHS than those who favour the current system of independent partners.
IPPR argues that these changes would also help address workforce pressures by allowing ‘doctors to be doctors’ and focus on patient care rather than managing ‘businesses and buildings’. This will enable GPs to have more time to care – the report recommends increasing appointment times to 15 minutes on average – while also being enabled to reduce their working hours.
Under the proposals, senior GPs would be offered management roles within the new NCPs, while newly qualified GPs would be offered salaried roles within these new organisations. This builds on the existing trends, with younger GPs preferring not to become partners and tending to opt for salaried or locum (agency) positions.
The report also calls for a radical transformation of the primary care estate, which is too often unfit for purpose because of chronic underinvestment by GP partners unable to access the financing they need. IPPR argues that the government should commit £500 million annually for a decade in England, through borrowing, to build 1,300 new primary care hubs and invest in new technology to enable digital access to primary care.
Harry Quilter-Pinner, IPPR Senior Research Fellow and report co-author, said:
“We are facing a crisis in general practice. Patients can’t get access to the care they need. Staff are overwhelmed by workload pressures and stress.
“Since 1948 GPs have been small, local, private contractors. But this model is no longer working. We need to join up primary, community and mental health care in new ‘Neighbourhood Hubs’ and give patients access to the best care when they need it most.
“This requires us to finally welcome GPs fully into the NHS family through a new right to direct NHS employment.”
Chris Thomas, IPPR Research Fellow and report co-author, said:
“Our approach to general practice hasn’t changed since 1948. Seventy years later, that system is at breaking point.
“We’ve seen a collapse in recruitment, soaring GP workloads and too few patients receiving the care that’s right for them. It’s bad for patients, and it’s bad for family doctors.
“There’s an urgent need for a new deal for general practice. At the heart of this must be better pay, conditions, flexibility and work life balance for hardworking general practitioners. It’s time to let doctors be doctors.”