Removing urgent care from GP practices as part of plans for neighbourhood health centres could ‘disrupt relationships’ with patients and lead to worse outcomes, the RCGP has warned.
In its submission to a consultation on the NHS 10-year plan, the college said that the Government must define a ‘clear’ national vision for its plans of neighbourhood working within the NHS.
It comes after several ICBs around the country drew up different neighbourhood models, including the use of ‘same-day access hubs’ leaving GP practices with only ‘complex’ patient care, and patients being triaged by 111 call handlers and seen in a ‘neighbourhood hub’.
Expected in spring 2025, the 10-year plan will be ‘underlined’ by a shift from ‘hospital to community’, with plans to deliver ‘neighbourhood health centres’ where GPs work under the same roof as district nurses, physiotherapists, health visitors and others.
But the RCGP said it would like to see general practice teams ‘at the core of a neighbourhood service’ and expects that the approach to neighbourhood working would work best if based on PCN footprints of 30-50,000 patients.
The college added that under this model practices would ‘largely retain’ their existing patient list sizes and geographical locations and ‘maintain connections’ to local populations.
It said: ‘Working at too large a scale or removing certain services, such as urgent care, from general practice could disrupt relationships between staff and patients, leading to worse experience and outcomes.
‘Relational continuity is a critical part of the Government’s ambitions to “bring back the family doctor”, and neighbourhood working must be delivered in a way which safeguards these relationships.’
It also said that many existing practices and PCNs are ‘already working closely’ with wider community services, and the RCGP would like to see these ways of working ‘enhanced’ rather replaced them with ‘more centralised’ hubs.
Most recently, North West London ICB drew up first-of-its-kind plans to introduce 25 ‘integrated neighbourhood teams’, each made up of one or more PCNs and of about 100 staff members, looking after a population of 50,000 to 100,000 residents.
These plans were inspired by Professor Claire Fuller’s landmark review from 2022, which argued that urgent care could be organised around single teams ‘in every neighbourhood’.
The RCGP submission also argued that a review of all GP funding streams including the Carr-Hill formula and QOF is needed as part of the 10-year plan.
The college would also like to see a duty for health secretary to report annually to Parliament on the proportion of NHS spending in general practice and primary care, as is currently done for mental health spending.
Similarly, each ICB should be required to report this proportion annually and held to account for ensuring it increases year on year, it argued.
The RCGP said that as part of Labour’s plans to move care into the community, there needs to be a commitment to improve practice premises, reiterating its demand for ringfenced investment of at least £2bn in GP infrastructure.
It added: ‘General practice is ideally placed to be at the core of a revitalised, well-resourced primary and community care sector. However, this shift will need to be carefully managed to ensure it delivers for patients.
‘It is critical that any shift in care is accompanied by a shift in resources. Investing in primary care leads to better health outcomes and delivers value for money to the NHS, the economy and society.’
Earlier this week, the BMA argued that the neighbourhood health services promised by Labour will ‘hinge’ on GPs, and that general practice need to be resourced ‘accordingly’ with a new GP contract and adequate funding.
The RCGP’s asks in full
Short term
General practice resourcing:
• The SoS should report annually to Parliament on the proportion of NHS spending in general practice and primary care, as is currently required for mental health spending. Similarly, each ICB should be required to report this proportion annually and held to account for ensuring this increases year on year.
• Protect patient safety by introducing a national alert system to flag unsafe workload levels and allow practices to access additional support.
• Provide organisational development support to general practice to implement new ways of working, building on the General Practice Improvement Programme.
• Free up GPs to spend more time with patients by reducing top-down contractual requirements and bureaucracy and preventing the inappropriate transfer of workload from the rest of the health system.
Continuity of care:
• Deliver support for general practice to provide continuity of care to patients through quality improvement approaches that properly resource continuity as a core part of general practice. GP workforce:
• Undertake a comprehensive review of the LTWP with a focus on GP retention.
• Develop a National Retention Strategy for general practice that ensures national consistency via ring-fenced national funding, oversight, and guidance. o Each ICB should appoint a local GP retention lead and NHS England (NHSE) should link them together to support collaboration.
• Evaluate existing GP recruitment and retention schemes to ensure they focus on supporting socioeconomically deprived areas. Implement additional schemes where needed.
• Fund the roll out of the People Promise across general practice.
• The Home Office should grant IMGs across the UK the right to apply for Indefinite Leave to Remain once they qualify as GPs, and NHSE should reinstate the IMG practice matching service.
Ways of working:
• Increase the use of group consultations in general practice to support patients with similar conditions to learn from each other with clinical support.
• Continue to expand community diagnostic hubs, making services more accessible to patients.
Medium term
General practice resourcing:
• Ensure patients get the care they need, closer to home, by increasing the share of NHS funding for general practice.
GP workforce:
• Establish an independent workforce projection statutory body.
• As part of negotiations between the Government and the BMA, protected learning time for GPs should be incorporated into a future iteration of the GP contract.
• Guarantee ongoing funding for Practitioner Health services for all health and care professionals employed in the NHS.
• Expand training capacity in general practice – physical space and capacity of educators/supervisors – to allow for increased GP numbers above and beyond current Government targets, particularly in socioeconomically deprived areas.
Ways of working:
• Review the GP contract and commissioning arrangements across primary and community services to allow for smooth referrals and coordination between teams, particularly for vulnerable patients or those with multiple conditions.
• Empower patients with greater access to a wider range of services using a piloted and evidence-based approach, as is done in some services (e.g. primary mental health, smoking cessation, drug and alcohol, physiotherapy, pharmacy and ophthalmology).
• Strengthen patient voice in general practice and any future neighbourhood service, building on Patient Participation Groups, to ensure a say in local ways of working for the benefit of communities.
• Adopt the principles of realistic medicine and prudent health, which promote shared decision-making between healthcare staff and patients, and to minimise unnecessary medical interventions.
• Explore moving public health responsibility back within the NHS to promote and facilitate prevention efforts.
• ICBs should have a specific GP representative in addition to a wider primary care representative, and Boards should be required to ensure there is balance between any additional representatives from secondary care with those from primary and community care.
Community care:
• Increase funding for expanding the number of community nurses and nurses in settings such as schools to promote early prevention and child health.
• Expand Community Health Wellbeing Workers as piloted in over 25 sites in the UK to proactively provide health wellbeing services within local communities.
Digital services:
• NHSE should invest in upgrading the current general practice IT infrastructure. This should include ensuring practices have access to sufficient PCs and laptops, high-quality software, fast broadband, and modern functioning booking systems.
• Increase investment in digital innovation and the organisational support to implement improvements to how practices operate, enhancing patient experience, efficiency, and connectivity with other parts of the healthcare system.
• Expand the information available on the NHS App to support with referrals and waiting list management so that patients can see the status of their referral, and advice on how to improve their health prior to being seen in secondary care.
• Improve data interoperability between different parts of the NHS, particularly primary and secondary care, to ensure information is more easily accessible for direct care.
• Implement electronic prescribing across all NHS settings to reduce the use of paper prescriptions, support continuity of care, and reduce bureaucracy.
Health inequalities:
• Review all general practice funding streams to better match resources with patient need, alongside increased investment across general practice.
• Site new medical schools in socioeconomically deprived areas where possible.
• Ensure all practices across England have access to high-quality data and analytical tools that facilitate understanding of their community’s health needs.
• Produce a cross-government strategy to reduce health inequalities, which commits funding to reduce the impact of social determinants on population health.
GP premises:
• Give every patient access to a modern fit-for-purpose general practice building, by investing at least £2 billion in infrastructure.
• Provide a flexible framework, streamlined processes, and adequate ringfenced funding, for practices to retrofit, improve energy efficiency and reduce their carbon footprint.
Sustainability:
• All NHS medicine procurement should include an environmental impact assessment, requiring the pharmaceutical industry to provide standardised environmental impact information.
• Medicines recycling and re-use schemes should be expanded across the UK, particularly focusing on inhalers.
• NICE should include information about the environmental impact of medicines in their guidelines and publications.
• NICE should update their guidelines to incorporate non-medical and nature-based interventions as a specialised category, where evidence of benefit is available.
• Adapt GP incentive schemes to encourage a stronger focus on delivering quality improvement approaches to sustainable healthcare.
Long term
• Ensure long term significant investment into primary care, hardwiring the importance of resources following any shift of care into NHS planning.
• Reducing the risk of premises ownership and lease holding for GP Partners by ensuring NHS premises payments and reimbursements meet full practice costs.
• As suggested by the 2019 Independent Partnership Review, introduce the option for GP Partners to shift to a different legal model, such as Limited Liability Partnerships.
Source: RCGP
Thanks again RCGP. There is a reason I am not a member and thanks for confirming no change there from me or like-minded colleagues
In touch with the people who do the job on the ground…as always
In the age of increased phone triaging, e-medicine, photo medicine, and little personal ‘weekend work’ or nights on-call, (use OOH instead), fewer week days spent seeing actual patients in real surgeries, more part-time GPs, or more (?working) from home, more admin time and study time, extended holidays and Bank holidays, no time spent immunising patients and their young children personally (from cradle to grave, getting to know families well), fewer clinics spent cooperating with midwives to examine pregnant patients, (and so getting to know patients at crucial times in their lives), more delegating to PAs, specialist nurses, pharmacists, HCAs and others too, more use of locums or salarieds with their precise ‘clock-off’ times more relationships (or problems) with your computers, so diverting your attention from your patients, more citywide (?useful?) GP meetings with simultaneous closure of your surgeries, or more training days, less seam-free connection to secondary care, and more tech and AI moving forward no doubt, with even more disruption of patients’ relationships ahead. So, while some of these matters benefit some people some of the time, overall the relationships with the patient and continuity of care become more and more eroded with time. RCGP should perhaps have spoken out a long time ago, so sadly, what real difference would the removal of urgent care from GPs actually make at this late stage? Such a pity, and, RCGP, irredeemable probably.
Fully agree Sam
And it’s good to see some UTIs, URTIs, impetigos, and chicken pox sometimes
It’s wholesome, innocent, and nostalgic
Like Ralph Fiennes lovingly grilling the cheeseburger at the end of The Menu
Yes Dr Liam, but you see the news item was actually about ‘disrupting relationships’ with patients which is on-message and fully addressed here. Less disruption of an extremely important core issue is fundamental.👍
I agree with you Sam – my post might have sounded sarcastic but I assure you it wasn’t !
all of our interactions with patients, even trivial ones, build up over time to create a relationship that then becomes a therapy in itself