Ben Gowland was excited by the promises made in the General Practice Forward View (GPFV) last year but, in this blog at the time, he expressed concern about the lack of any kind of accompanying financial plan. Now the government has published a “next steps” document which outlines the key priorities for the NHS over the next two years; and those concerns appear to be well founded.

There are 6 things general practice need to know about this document:

1. There will be £1bn less investment into General Practice than expected

In a cunning sleight of hand, the document reveals in a graph on p18 the promised £2.4bn additional expenditure into general practice uses a start point of April 2013, not the publication date of the GPFV (April 2016).   As well as leaving a bad taste in the mouth, it means the “extra” from 2016 is closer to £1.4bn, with the rate of growth of increase slowing from 2017 (now) onwards.

2. “5000 additional GPs” will become “the highest number of GPs in training ever”

Instead of saying there will not be an additional 5000 GPs and fronting that out, the document trails what will undoubtedly be the line the government and others will take in future that there are more GPs in training than ever before.

3. Extended Access is all

The one part of the GPFV the government really does care about is extending GP access. “By March 2018, the Mandate requires that 40% of the country will benefit from extended access to GP appointments at evenings and weekends, but we are aiming for 50%. By March 2019 this will extend to 100% of the country” p19. The additional funding for access, meanwhile, does not kick in until April 2019 and April 2020, a fact the document makes no attempt to address.

4. QOF will go, and be “reinvested”

Any practice bruised by the recent PMS reviews or removal of MPIG may be nervous to read the following, “We will seek to develop and agree with relevant stakeholders a successor to QOF, which would allow the reinvestment of £700M a year into improved patient access, professionally-led quality improvement, greater population health management, and patients’ supported self-management, to reduce avoidable demand in secondary care”. GPs are rightly nervous of the term “reinvestment”, as it generally means expecting them to continue doing what they are doing now, as well as undertaking additional activities to earn exactly the same amount of money, or even less if some of that “reinvested” money is siphoned off into networks, hubs, or CCG financial positions.

5. 30-50,000 is definitely the magic number

Most practices are seeing the writing on the wall that getting to this population size is going to be necessary one way or the other, but this document clearly reaffirms it. Badged as encouraging practices to work in networks or hubs, it clarifies (underlined) “the model does not require practice mergers or closures” (p21), while at the same time promising funding incentives to accelerate the move to reach this magic population number.

6. GP-led CCGs will be usurped by more powerful STPs

The whole section on STPs is crafted as a work around legislation to take responsibility away from CCGs and give it to STPs, and in some cases turn them into something called Accountable Care Systems (ACSs). These “will be an evolved version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health” (p35).

Nearly exactly one year on from the publication of the GPFV it feels like we have just moved two steps backwards from the forward steps of last year. Then it felt like the current plight of general practice was recognised, whereas now that recognition feels absent once again, replaced instead with a simplistic view that operating at scale is a straightforward solution and an almost blinkered focus on extending GP access.