Who has the answer to the crisis facing General Practice? Ben Gowland argues that it is not the politicians, or indeed anyone who believes in an imposed, top-down intervention. The solution has to come from General Practice itself.

We all know General Practice is in crisis. What we seem to be lacking is a sensible plan for how to tackle it.

The Government’s approach is relatively straightforward. They have promised more money (4-5% each year until 2021), more doctors (5000 more by 2020) and less bureaucracy. They are going to encourage GP practices to operate ‘at scale’ by offering a new voluntary contract for practices that cover a population of 30,000 or more. And in return they want 7-day access to GP services.

Sounds simple. But there is a fundamental problem with this approach – we know it is not going to work. The financial problems in General Practice are NOT going to be solved by the additional funding (less than half of GPs think it will have a significant positive impact on the problems they are currently facing). The recruitment problems are NOT going to be solved by the extra GPs: GPs are leaving, retiring and emigrating far faster than new ones are joining. And a huge 90% of GPs think that the introduction of 7-day working will only make their problems significantly worse.

The current crisis in General Practice will NOT be resolved by a new contract, a 10-point plan, or a series of ‘interventions’ from on high. Offering more money to GPs for working harder or longer hours when they are already at breaking point is just likely to send them over the edge. Shouting louder at practices that are struggling or increasing the number of inspections or applying stricter and stricter contract penalties are NOT going to work – they will simply make the situation worse.

So what WILL work? However dire the current situation you can’t just force or manipulate General Practice into changing. A completely different approach is required. It needs leadership that will inspire those working in General Practice (who are variously tired, frustrated and burnt-out) to believe that change for the better is, in fact, possible. The group interest of General Practice (and thus their patients) needs to be set as the priority, as a means of stimulating followership. Change needs to start with, and build on, the values, ideals and needs of General Practice.   And it needs a focus on innovation, on doing things differently and doing different things – rather than the execution of someone else’s plan that no-one really believes will work.

Where this type of approach has been used, we have seen the green shoots of success. I spoke recently with Mark Newbold, the Managing Director of Our Health Partnership, the new ‘super-practice’ formed from 32 previously existing practices in Birmingham. Inspired by the vision presented to them, the member practices committed to the new model. They dissolved their old partnerships and created a new one. The model is working because the organisation has created trust between the leadership and the members. This is because its primary focus is on the needs of the members and their patients and because it is striving to deliver on its promise that the benefits of operating together at scale will outweigh the loss of independence and start-up costs. In Mark’s words, it remains a “grass roots movement”.

But it would be a foolish Whitehall mandarin who interpreted this as meaning that super practices must be the “answer”. What this example demonstrates, though, is that the “answer” must come from locally-led change, focussed on listening, collaboration and leading by example. The plan for General Practice can’t start with the answer. Imposing change on General Practice will make things worse. But a plan that strives to build trust, to create an environment that encourages new ways of working, and to enable and empower GP practices to transform themselves, is the one most likely to succeed.