“If I had an hour to solve a problem I would spend 55 minutes thinking about the problem and 5 minutes thinking about solutions” Albert Einstein

Why is all the effort being put into general practice workforce not working?  Two and half years after the publication of the GP Forward View GP numbers continue to fall, workload continues to rise, dissatisfaction continues to grow.  We are told the money is being invested.  So what is going wrong?

The NHS England workforce plan is pretty simple: increase the number of GP training places; attract overseas doctors; provide financial incentives for GPs in hard to recruit areas; recruit an additional 1500 clinical pharmacists; co-locate an additional 3000 mental health therapists; introduce 1000 physician associates to general practice.  All the individual elements of this plan are reportedly on track, so why is it not working?

In short, it is because we have jumped to solutions without spending enough time understanding the problem or thinking about the change process required to make solutions successful.

Do practices want clinical pharmacists, mental health therapists and physician associates?  Some do and some don’t.  Practices are independent businesses; creating roles that practices don’t want isn’t going to help.  Each practice ultimately has to choose to pay for any new roles.  The problem isn’t insufficient physician associates.

It is too big a jump to move from a case study of a practice, or group of practices, who have developed a solution to their specific workforce challenge, to then assuming this solution will work for all practices.  Making it national policy, and performance managing each area on delivering it is a change management approach that won’t work with GP practices.

Each area is different.  Each practice is different.  The workforce problem manifests differently in each area and each practice.  Where the problem is different, the solutions needed, and how they are implemented, will be different.  For a solution to work, it needs to be owned by the practice not imposed from above, yet this is where we currently are.

What, then, is the alternative?  Each area should work out how they want their specific challenges to be addressed.  Practices need to work out what they want to do about their problems, and own their own solutions.  They need to set the agenda.  The majority of practices are now in some form of primary care network.  This is an ideal grouping for practices to work together to identify the changes they want to make, such as employ paramedics to undertake a joint visiting service, build GP-led clinical teams for populations of c5000, create a multidisciplinary team to manage the on the day demand etc etc.  Each area should identify the solutions that will work for them.  This should then drive the workforce plan, not the NHS England targets.

Each local area currently has to justify how it is complying with the national workforce plan.  This approach is never going to work.  The whole approach needs turning on its head.  Local groups of practices should be shaping the agenda.  The available funding should be focussed on helping practices to work out the solutions that will work for them, and on helping them implement them.  Regional workforce organisations should be accountable to these group of practices, not to national organisations.

If we are going to start making inroads into the workforce crisis in general practice, we have to accept the current approach isn’t working, and start doing things differently.