Recently I have been wondering if we have been going about tackling the challenges in general practice all wrong.

We have been focussing on the problems practices are experiencing now, and trying to systematically tackle them one by one. Logical. But it assumes the cuts are only superficial, and once they are patched up individually general practice will be well.

The General Practice Forward View (GPFV) approach is to identify each of the issues general practice is facing, and to come up with “answers” for all of them. So for example workforce is the issue and 5000 more GPs is the answer. Or infrastructure is the issue and the ETTF (estates and technology transformation fund) is the answer. Or workload is the issue and contract changes to stop secondary care increasing general practice workload is the answer.

You could argue the real issue is underfunding, and that more money is the answer. But despite the rhetoric, there never was an extra £2.4bn for general practice (see here for more detail). In 2016/17 not only was funding flat (taking into account inflation), growth was half that received by acute trusts. We operate in the system we operate in.

But whether or not the “answers” are working individually, they certainly are not working collectively. I don’t think it is a failure of implementation. Rather, the approach was wrong in the first place. Wrong because it started with the problems, not the strengths of general practice. It started with individual challenges, rather than a compelling vision of the future. And it started with the premise of offering more within a system that cannot offer any more.

Compare this with the NAPC’s primary care home initiative. I knew quite a lot about it, but what I couldn’t quite comprehend was how it helps general practice meet its current challenges. I spoke recently to Dr Nav Chana, Chair of NAPC, and asked him about this. What I learnt from that conversation was the starting point of the primary care home is not so much the sustainability of the current organisational infrastructure of general practice, but a desire to improve the health of local populations, to bring increasingly fragmented workforces together, and to put the control of resources for that population into one place.

What that then means for GP practices as organisations they don’t know yet. What they do know is they are building on the strengths general practice currently has, they are making the service attractive to those who work there again, and that by focussing on meeting the needs of the local population the most appropriate future form of general practice will emerge.

It makes sense. A model that meets the needs of a defined local population will solve recruitment problems because it will attract staff to work there, will solve financial challenges because it will attract investment and funding, and will solve workload issues by different staff groups all working effectively as an integrated team.

Of course it will need help to get there. But by using a future focussed and population centred approach, the primary care home initiative has much more chance of providing general practice with a realistic route out of its current malaise than the backward looking, issue based approach of the GPFV.