On Saturday the Times reported a plan by Sajid Javid to ‘nationalise’ general practice.  It seems (once again) general practice has become something of a political football.  What are we to make of this latest report?

We need to put this latest development within the context of everything that has happened in recent months.  In October last year the government, clearly frustrated by complaints in the Mail and other elements of the press about challenges with access to a face to face appointment for a GP, pushed NHS England into the production of their document “Our plan for improving access for patients and supporting general practice”.

As a result the profession, already incensed by the lack of support from NHS England earlier in the year over the same issue, voted in support of a mandate for strike action.  Not, one would think, the response the government was looking for.

At this point (in November last year) the Health and Social Care Committee, now led by a transformed Jeremy Hunt seeking to use his position chairing this committee to undermine the government at any point, launched an Inquiry into the Future of General Practice.  Evidence for this inquiry can be submitted until this Friday, 4^th February.

The Times article indicated that a review of General Practice is “planned” by Javid, so we can assume this is not the same as the Health and Social Care Committee Inquiry.  There are undoubtedly politics that we are not aware of between Hunt and Javid also at play, but what the Secretary of State certainly won’t want is Hunt’s Committee telling him what he should be doing with general practice.

The other important piece of context for this article is the wider shift to integrated care, and what this means for general practice.  As I discussed a couple of weeks’ ago, the Planning Guidance for the NHS seems very geared towards the role general practice can play in support of acute trusts, in particular in relation to the rollout of thousands of virtual wards.

A review of PCNs was also announced in November last year, and interestingly this review is now framing itself in terms of what “integrated primary care” looks like.  In this video the leader of the review Clare Fuller does not reference PCNs once.  This review is due to report next month, so it is not beyond the realms of imagination to think that this is the review that Javid is referencing in the Times article.

This would also explain the timing of the article, although of course all this is being carried out at exactly the time that the newly elected GPC committee, armed with their strike mandate, are negotiating the first contract.  This government, for longer than most of us can remember, wants better access to a GP above all and everything else, and if negotiations are not going well this might be the perfect time to threaten nationalisation to move things along.

The argument for organising health services around the needs of hospitals (as opposed to the health needs of the population) is so antiquated that it is hard to believe that it is being taken seriously.  That said, with this government anything is possible, and there are disturbing trends within Integrated Care Systems and the guidance around them towards creating primacy for the needs of hospitals.

But overall my sense is that general practice has very much become a political football, and that most of this is political game playing.  I don’t really think Sajid Javid wants to nationalise general practice, and to end up in a full on dispute with the profession, but I think there are things that he does want and reports like this are simply a means to help him get them.