There are some far reaching implications of the Fuller Report for general practice.  However, getting underneath exactly what they are and understanding what the report means for practices is far from straightforward.  For me this is primarily because of the way this report has been written, published and launched.  I have picked out four points to note about this here.

The first is that it is not a report about the future of general practice.  Indeed, the report goes to great lengths to insist that it is about all the different parts of primary care, and even then that is about how primary care should be ‘integrated’ not about its future per se.

There is, however, no escaping the fact the two are inextricably linked, despite this seemingly being something the paper tries as far as it can to ignore.  To give two examples: the paper pushes hard for resources for general practice to shift away from the national contract to come under the discretion of local systems (“Beyond 2023/24, maximise system decision making on any future discretionary investment, beyond DDRB and pay uplifts” p35); the paper also mandates that there should be a single system of managing urgent care in every neighbourhood (i.e. across practices).

These are huge changes for general practice, so it does seem specious to argue that this is only about primary care integration and not about the future of general practice itself.

Which brings me to the second point about the paper.  It is not an options paper, or a discussion paper, but is rather produced as a fait accompli – that this is the only possible way forward.  The paper outlines what it describes as a ‘vision’ of the future, and finishes with the actions needed to begin its implementation. For such a radical change you may have expected a period of discussion, deliberation and consultation, but because this is about ‘integration’ not general practice there is apparently no need.

The third point to note is that the paper is not an easy read.  There is no easy to navigate contents page, no numbering or anything to help an unseasoned observer make sense of what they are reading.  There is a great deal made of the three elements of the new vision, but very little on the what all that means for the existing models and ways of working.  In some ways I was left at the end of the paper feeling that much more was implicit than explicit.

The fourth point is about the launch of the paper itself.  The report is accompanied with a letter of support from all 42 of the ICS Chief Executives.  It is explicitly noted in the document that the Chairs of 9 workstreams and 4 task and finish groups all “endorse its findings” (p37).  Following the publication of the report there were then lots of seemingly pre-orchestrated messages of support for the report and a reinforcement of the idea that this is the only possible way forward.  Have a look at this message from the Chair of the RCGP, and even this one from the BMA.

Now it may be that all of these organisations were fully engaged in the production of the report, and what has emerged is a consensus model that all parties concur is the best way forward.  I just find the lack of any clearly articulated implications of the report surprising (in particular from the BMA and RCGP), even if they support the report.

All of this leaves me with the sense of a very highly politically managed process with the report trying to be pushed through, without the debate and discussion that you would normally expect for such a significant change.

It is for individuals to make their own mind up about the attractiveness of the vision laid out in the report and the extent to which they sign up to the proposed way forward.  My ask would be that more clarity is brought to the implications of this report for general practice before these decisions are made, but my fear is that rapid national agreement will quickly push any real debate to a local level and the course will already be irreversible.