2021 has been quite a year.  What can we takeaway from everything that has happened, and where are we now as move towards 2022?

The year started with the vaccination programme (in a way hugely reminiscent of everything that is happening right now).  When things were critical, and a fast response was needed, it was general practice that the NHS (and the government) turned to.

For the first months of this year, the vaccination programme was exhausting.  There were real concerns that the programme would prove to be too much for general practice.  One GP predicted at the time, “Prediction for GP in England. It will deliver on the vaccination demands. Delivered for most partners at a loss because of the awful NHSE and GPC ES. Once the pandemic is over many GP partners, PCN CDs and practice managers will resign, broken.” (here).

While we didn’t end up with mass resignations, there was certainly a withdrawal from the programme by many because the constant demands were proving simply too much.  And when the delivery demands of general practice as a whole were increased in April, despite the ongoing demands of the vaccination programme, it did raise the question of who is looking after general practice?

No one, it transpired.  As complaints from the worried well emerged via sections of the press, rather than defend the over and above contribution already made by the service NHS England responded with a letter in May mandating practices to offer face to face appointments.  Understandably, this did not go down well.

Despite some huffing and puffing, at the time no real response was made by the service, much to the consternation of many.  But a few months later NHS England’s publication on improving access and “support” for general practice (essentially how they were going to performance manage practices into offering more face to face appointments) proved to be the straw that broke the camel’s back.

By this point the demand on the service had become so great that the model of access to general practice now required a virtual or telephone triage to protect the face to face appointments for those who really needed them.  Instead of supporting the use of this model, and helping to explain it to the wider population, ministers and NHS England spent time on national TV promising anyone who wanted a face to face appointment with their GP that they could have one.  Nothing could have been either less helpful or more incendiary.

As a result the BMA balloted on industrial action, and supported by the service it now has a mandate to take into next year.

The other big development in 2021 was the shift of the whole systems towards integrated care, as a replacement for the historic commissioner provider split.  The White Paper was published in February, and while it is still making its way through parliament the NHS has been moving at pace to be ready for its approval and it becoming legislation.

It has been a challenge trying to work out what the new system means for general practice.  Design guidance followed for the service in June, and we started to understand the importance of local place based arrangements for general practice, as well as the role of PCNs in representing practices in these models.

The big concern is that there will be a loss of influence for general practice.  While CCGs are (supposed to be) GP led, there is no such requirement of integrated care systems.  Indeed the formal role of GPs in the new arrangements is relatively limited, and leadership of the new system by general practice feels unlikely.  But, as ever, general practice has worked its way through the issues, and areas have worked out that by PCNs, federations and LMCs coming together general practice can have the strongest voice in the new system.  The overall strategy needed is one of pushing decision making to the most local level possible, working together to create a single local voice for general practice, and then using this voice to influence decision making locally.

Here we are at the end of the year, with the service feeling very much on the precipice.  Integrated care systems are due to go live during 2022 (dependent on when the legislation finally gets approved), industrial action looms (one assumes depending on the outcomes of contract negotiations early in the new year), and covid is fighting back to add yet more pressure on to the service.

We have now come full circle with a new call to arms for general practice to once again lead the vaccination charge for the country.  Let’s hope next year there is both more appreciation for the critical role general practice plays, and more support for the service to recover from what has undoubtedly been one of its most challenging years ever.