The crisis in general practice has led to individual practices making changes, on their own at first and then increasingly together.  CCGs should be facilitating this process through their GPFV plans rather than introducing big picture change, argues Ben Gowland.

There is something going on in general practice. Change is afoot. While nationally all of the talk and rhetoric is around STPs, new models of care and operating at scale, practices seem to be taking a different approach. CCGs should take note.

At the risk of stating the obvious, general practice is not one organisation. It is 7800 independent, individual business units, all operating in their own way. While the contract they deliver against is (essentially) a national one, how they choose to deliver against that contract is up to them. And it varies significantly. No two practices work in the same way.

Despite its obvious drawbacks, this variation has created a huge opportunity. For every single practice there are better ways they could be doing at least some things. For some practices there are better ways they could be doing most things. And as the crisis in general practice has started to bite, the response has been (as is the way of general practice) pragmatic. Practices are starting to focus on how they do things internally. “How we have always done things around here” is no longer good enough, because it no longer works.

What is starting to emerge are changes with quite astonishing results. Hours of administration time removed because of changes to the way documents are handled. Huge reductions in DNA rates because of changes to the way appointments, and cancellations, are handled. Swathes of clinical work moved from GPs as a result of the introduction of different types of clinician into the practice team. New types of appointment creating more efficient ways of meeting the ever increasing demand. The lives of the duty doctors being literally transformed by internal re-shaping of how appointments are handled.

Making the first real change is always the most difficult. But once achieved it often creates a thirst for more. Practices that were previously impenetrable islands suddenly let the drawbridge down, keen to share their success with others, and are newly open to learning from the success of others. This sharing brings mutual success, builds trust and strengthens relationships that had grown cold through the winter of the crisis.

And out of this trust and these relationships further improvements and changes are found to be possible. Accountancy fees, indemnity fees, regulation costs (and more) are starting to be reduced by practices working together. More new roles are introduced. GP-led multidisciplinary teams enable practices to tackle the workload in different ways, freeing up GP time for the patients who need it most. Once the rock is moving, it develops pace, energy and impact, and more and more is achieved.

All around the country (but not everywhere) this is starting to happen. The hard bit is the first step – recognising there are other ways to do things, and then making the first change happen inside the practice. Talking about big picture change in locality or CCG meetings is not what is important. Arguments about the rights or wrongs of MCPs won’t help. It is only doing something differently at the individual practice level that has an impact, that can get things moving.

Which brings me to CCG GPFV plans. General practice is still in crisis. Don’t turn the plan into a strategic template for the introduction of MCPs, or a way to fulfil a requirement for 7 day working when 5 days is currently out of reach, or the creation of complex bidding processes for limited pots of money in the name of “equity”. Instead, use the plans to help practices take the first step, or if they have taken the first step the second, or the third, or whichever is the next step to build the momentum local practices need to find a way out of their current predicament.