Last week NHS England announced a new initiative in which it plans to test new ways of working in general practice to “optimise the general practice operating model”. But is there any sense that this initiative will help with the challenges GP practices are currently facing?

There has been a growing divide between the profession and the policy makers, and sooner or later things are going to come to a head.  The issue is that the problems practices want to solve (practice financial sustainably and workload) are not the problems NHS England is interested in.

Let’s start with some recent historical context.  Back in 2016 the GP Forward View was published.  This was manifestly an attempt to support general practice and provide it with the resources and support it needed to recover from the perilous financial position it found itself in at that point in time.

Then in 2019 (3 years through the 5 years of the GP Forward View period) this plan was superseded by the 2019 5 year contract that introduced PCNs.  This promised new investment into general practice in return for practices signing up to form part of PCNs.

The first year of this contract went reasonably well, but then Covid struck.  It was after general practice had been lauded for its role during the pandemic and throughout the vaccination programme that things started to change for the worse.

The PCN money never really found its way through to practices, and then in April 2022 we had the first of what has become three consecutive below inflation contract impositions upon the service.  In May 2022 the Fuller Report was published, which manifestly does not seek to address sustainability issues at practice level but rather how general practice can be “integrated” into the rest of the system, and despite that has become the default strategy for general practice at both a national and local level.

A series of NHS England personnel changes has not helped.  First Simon Stevens, who to be fair to him had always clearly articulated the importance of a strong general practice, left his role as Chief Executive of NHS England in July 2021 and was replaced by Amanda Pritchard.  Dr Nikki Kanani, who had been a strong advocate for general practice and supporter throughout the pandemic, departed from NHS England a year later.  Dr Amanda Doyle arrived as National Director for Primary Care, and Dr Claire Fuller herself was eventually appointed as the new Medical Director for Primary Care in place of Dr Kanani.

So ever since Amanda Pritchard, Amanda Doyle and Claire Fuller have been in post we have had three consecutive imposed contracts, disinvestment in core general practice, and a system focus on integrating general practice with the rest of the system via PCNs, with seemingly little or no concern as to whether practices are able to remain viable.

This is the context into which this new initiative to “test new ways of working in general practice” has been announced. The mindset appears to be one of how general practice can support the rest of the system, e.g. how integrated care teams can prevent admissions to reduce pressure on the urgent care system, with little or no attention being paid to the important direct contribution of general practice itself.

This latest initiative is symptomatic of the recent approach NHS England has been taking to general practice.  It starts with an assumption that the things that need to change are obvious, yet there is clearly a gap between what practices and what the system believe these things to be.  It continues to focus on “integrated neighbourhood teams” with no clarity (either within NHS England or outside it) as to what these are intended to be.  It bypasses traditional lines of communication with general practice (i.e. the GPC), instead choosing to unilaterally announce a series of pilots in a random set of ICBs.  And (as ever) it refuses to provide any funding, instead saying that ICBs should “commit reasonable resource” to the pilots.

So my prediction is that these pilots will end up alongside other recent pilots (multispecialty community providers anyone?) as something that gets talked about for a little while but that are ultimately ignored once policy makers decide what they are actually going to do.  In the meantime the challenges to the delivery of core general practice remain, and unless NHS England appoints leaders who take these seriously it is hard to see this changing any time soon.