By now you are likely to have either read the government’s 10 year plan for the NHS, or at least a summary of it, or picked up from others the key elements of the plan (my take on what the implications of the plan are for general practice is here).  The question now is how should general practice respond to the plan, both nationally and locally?

I recently spoke to Dr Katie Bramall-Stainer, Chair of the GPC, about the plan.  You can listen to our conversation here.  Her view is that the plan is not set in stone, but rather a signal of the start of an iterative process of how the desired reform should be delivered.

She does have real concerns about some of the suggested mechanisms for delivery in the plan, not least of which is integrated health organisations, which she says stands out as “a big red flag” and potentially poses an “existential risk” to general practice.  But rather than come out in opposition to the plan as a whole and risk having reform done to the profession, her view is that it would be far better for general practice to be part of shaping the changes as they develop.

It is hard not to agree with what she is saying.  General practice would run the risk of being sidelined if it decided to withdraw any engagement from the plan.  It would not be hard for the profession to be portrayed as being anti-reform, and the plan has already opened up routes by which change could be imposed on rather than negotiated with general practice.

But equally it will be important that engaging in discussions about shaping the reform are not taken as implicit approval of the ideas Katie has already identified concerns about, such as the integrated health organisations and also the multi-neighbourhood provider contract (specifically how it will be procured).

What general practice will need to do is not only dissect the plan, but also come up with alternative proposals as to how the ambitions of the plan can be realised where the initial proposals cause concern.  It very much feels like an opportunity exists now to shape the future, but simply rejecting the ideas that others put forward on its own will not be sufficient because no change is not going to be an option.

Almost immediately after the publication of the plan NHS England announced a “National Neighbourhood Health Implementation Programme”, and is seeking 42 local place areas to apply.  Given the concerns about the plan, but equally the desire to shape it, does it make sense for general practice to support any local application?

As ever the response is “it depends”, but what it depends on are the assumptions being made locally as part of the application.  What parts of the plan are being taking as a given and what parts are being tested?  For example, is the local area taking a multi-neighbourhood provider as a given and wanting to use the pilot to fast-track its procurement?  In this scenario, I would have serious reservations.  But if we have a trusted local at-scale general practice provider and the aim is to use this to enable effective neighbourhood development then maybe an application would be worth supporting.

What this highlights is that it is not only a national general practice responsibility to react to the plan and develop ideas on how the ambitions of the plan can best be delivered, but also a local one.  The plan correctly identifies that there will not be a one size fits all national solution that can be imposed everywhere.  Local solutions will be needed.  If general practice wants to shape the future locally, and not be a recipient of imposed reform, then it will need to support and potentially lead the development of local alternatives to the ones it has concerns about within the 10-year plan.