For general practice there have been some important documents written this year.  The three that particularly stand out for me are: The Fuller Review; the Future of General Practice (Health and Social Care Committee (HSCC) Inquiry Report); and Side Effects by David Haslam.

I have written about the Fuller Review and the HSCC report, and had the good fortune to be able to interview David Haslam about his book for the General Practice podcast.

While Side Effects is about the system as a whole, it is extremely useful for general practice as it seeks to better articulate its role as a provider within Integrated Care Systems.  David Haslam’s key question for the health system as a whole is what is the healthcare system really trying to achieve?  This, he claims, is a question that most of those responsible for healthcare systems are unable to answer.  Infinite demand and limited resources means systems cannot be universal, high quality and comprehensive, so what is the goal of the system?

We could apply this question to general practice.  Are we really clear as to what general practice is trying to achieve?  Are those leading general practice able to articulate clearly the purpose and role of general practice?

I remember even in my role as a CCG Accountable Officer that I was not crystal clear on the role of general practice in the system, and not fully able to articulate it effectively to acute trust Chief Executives and other system leaders.

It isn’t just me.  Ben Allen, a  Sheffield GP and Clinical Director, recently posted on Twitter,

💥Primary Care has no clarity on:
🌟Why we exist
🌟What matters most
🌟What ‘good’ looks like
🌟Our responsibilities in the system
(Shared vision & Purpose)
So priorities & expectations constantly conflict: Gov, staff, public & media

We need agreement on such FOUNDATIONAL issues

— Ben Allen (He/Him)💙 (@BenAllenGP) November 14, 2022

The Fuller Review seems to distil the aim of general practice as to provide rapid access to care, to provide continuity of care for those who need it, and to play a role in prevention and tackling health inequalities (in partnership with others).

Is this right?  Is this what general practice is there to achieve?

The HSCC Report again is not explicit, but does use this quote, “[T]here are two characteristics of general practice which distinguish the GP from every other professional: first, access and, secondly, continuity of care. That is all there is and everything else supports that.” (p19).  The report broadly states that access has been over-prioritised over continuity of care and that this balance needs to be redressed.

So is the HSCC report right?  Is the role of general practice to provide access and continuity of care, and is the challenge to get the balance between the two right?

David Haslam did not explicitly address the question as to the role of general practice, but he is clear that the challenge for general practice is that much of what it does is not glamorous enough for politicians and the system.  The system does not value the heart attacks and strokes that general practice prevents, because it is not as glamorous as the service that treats a patient who has had a heart attack or stroke.  Even the patient whose heart attack or stroke has prevented does not know that general practice did this!

What he does say is that by investing in primary care health inequalities are reduced and health outcomes are improved.  Is this what general practice is trying to achieve?  And if it is, are we clear exactly how this happens?

Even now I am not sure I can fully articulate the answer myself.  However, the assumptions in the recent publications feel insufficient and inadequate to me.  I am sure that general practice as a profession is not articulating its purpose and role clearly enough.  I don’t even believe there is a shared clarity within the service itself on where the true value of general practice lies.

In the vacuum, the system and politicians just work with their own assumptions.  Acute trust leaders believe many of the patients in A&E are there “because they couldn’t get to see a GP”.  The assumption is that the prevention work of general practice is linear, that general practice stops the need for further care directly and only as a result of its accessibility.  Politicians believe that the aim of general practice is simply to be available when patients want it – hence the obsession with access.

We can´t let these misconceptions continue.  There is a pressing need for general practice, both at a local and national level, to be able to articulate the role of general practice in the system and what it is trying to achieve.  The advent of Integrated Care Systems means it is more important than ever that general practice is clear on the value it brings to the system and exactly how this is achieved.