One of the few slithers of hope that we have had in general practice in recent months came from the most unlikely source.  Jeremy Hunt, in his stint as the Chair of the Health and Social Care Committee, commissioned an Inquiry into the future of general practice, and the report the committee published was surprisingly sensible.

The report contained a call for the government to acknowledge the crisis general practice faces, to recognise and prioritise the importance of continuity of care, and to strengthen rather than undermine the partnership model.  You can read the full report here.

The report was published in October last year, and the usual requirement is for the government to respond to such reports within 2 months.  However, in an indication of what was to come, the response took 9 months to arrive, and if I was to use one word to summarise the response it would be “disappointing”.

Maybe it was unrealistic to have any expectation that the report would carry any real influence, but it did seem to have been championed by Jeremy Hunt, who then went on to become Chancellor of the Exchequer, so there were some legitimate grounds for hope.

Unfortunately, you don’t need to get far into the report to realise that it is going to result in no actual change of direction.  Recommendation 1 was that the government acknowledge there is a crisis in general practice.  The response?  The Department “partially accepts” this recommendation, only in so far as some people are facing challenges in accessing an appointment, and the Delivery Plan for Recovering Access to Primary Care has been published to address this.  And that’s it.  If the problem won’t be acknowledged, you can be pretty sure there will be no support to follow.

Essentially the response says that if you take the Fuller Report, the Plan for Recovering Access, the Hewitt Review and the Long Term Workforce Plan, everything that needs to be done for general practice is already being done, and no further action is required.

It explicitly rejects the call to prioritise continuity of care (the main call of the initial report), and responds with, “we note that continuity of care needs to be pursued alongside a parallel focus on access” p13.  The government’s prioritisation of access over continuity isn’t going anywhere soon.

In response to recommendation 26 that the government should reaffirm its commitment to the GP partnership model, it says “The Government confirms there is currently no policy to abolish the partnership model” p21, but then goes on to say, “we wish to support a range of models of primary care provision, including the partnership model”.

In the introduction to the report (p2) it goes a bit further and states, “Realising this broader vision may require significant changes to the way general practice operates and is contracted today. Over the course of the year, we aim to engage with the professions, patients, ICSs, and key stakeholders, on a broad range of themes including contracts, operating models, funding of GP IT and estates, to help inform how to shape general practice for the future.”

There is no doubt, it seems, that further change for general practice is on its way.  The document continually refers back to the Fuller Report as the blueprint for this change.  The Fuller report called for “national partners/DHSC and NHS England” to undertake changes to “the existing legislative, contractual, commissioning, and funding framework, which were out of scope for this stocktake”, and it looks like this process is about to begin.

What this response really highlights is that we are about to have a problem.  Its authors don’t believe a sustainability problem exists in general practice.   They do not value personal lists, continuity of care, or manageable list sizes.   Instead the issues they want to address are those of integration and access. This dissonance as to the issues that need to be tackled between the profession and policy makers is where the root of the conflict to come will lie.