The future general practice workforce

The focus within general practice in recent months has (understandably) been on the need for more GPs and to strengthen the more traditional practice workforce. This has been accompanied by a growing disquiet with the new workforce brought in via PCNs and the additional role reimbursement scheme (ARRS), including with the new non-clinical roles. But how is the workforce likely to develop in future, and could it be that we will see more rather than less of these roles?

General practice feels like it is in limbo at the moment. The 2019 five-year contract came to an end in March, and was simply rolled over into this year with no sense of a future direction. Now we have a new government in power that says it wants to increase the percentage of NHS funding that goes into primary and community care, but we are waiting for the plan for how this is going to happen. 

Meanwhile the status quo is crippling, to the point where practices have embarked upon collective action to push for more resources. Not only that but there is a growing undercurrent of resentment to the five year contract, to PCNs and to the ARRS workforce, largely because of the situation practices now find themselves in. 

The natural tendency when times become difficult is to look backwards to when the situation was better, and to want to recreate the world as it was then. The perspective is that if we just had things now like they were before then everything would be ok. As a result, the push has been for more GPs rather than the growing number of additional roles. Insufficient funding aside, the muted response to the new ARRS pot for new GPs is essentially because it has been created alongside the additional roles rather than instead of them.

But if we look forwards rather than backwards and consider the direction of travel for the NHS as a whole and for general practice within that, then it may be that what is needed is an even more diverse workforce, with even more non-clinical roles.

While we do not yet know the content of the next NHS plan the new government has been clear on two things: one, that it wants to move the NHS to a ‘Neighbourhood Health Service’ to try to develop better coordinated, more local approaches to health and care delivery; and two, as the Prime Minister is so fond of saying, that there will be no new funding without reform. 

What will moving to a neighbourhood health service entail? There are some clear pointers to this in the NHS Confederation’s recent publication ‘Working Better Together in Neighbourhoods’. This essentially says PCNs will need to evolve into, or become part of, integrated neighbourhood teams (INTs), which will bring together professionals from health and care providers as well as voluntary, community and social enterprise organisations – i.e. a much wider range of professionals than currently exist within PCNs. 

The report ends up by recommending that not only should the GP contract be revised so that it can play a leading role in neighbourhood health models, but also that primary care resources should be aligned around neighbourhood priorities. Specifically, it states, ‘This includes workforce strategies that reflect requirements for neighbourhood working and that encourage providers to include neighbourhood team working in job descriptions and job plans where possible’.

All the signs are that the new NHS plan will not be looking to reinforce the independence of general practice, but rather to offer more resources in exchange for reform whereby general practice actively accelerates neighbourhood working. This will mean general practice working with an even wider range of professionals, many of whom will not be clinical.

The choice for general practice moving forward may well be the extent to which it wants to take on a leading role in the development of these new neighbourhoods. It could choose to focus only on core service delivery and leave anything else to others. But the cost of this is likely to be the ongoing independence of the service, with other organisations playing a much more active role in both the development of neighbourhoods and how general practice will function within them.

If, however, general practice chooses to build on the foundations of PCNs and play a much more active leadership role in the development of neighbourhoods, then it will be much more likely to retain control over its own future. But in this scenario the ARRS workforce, and in particular the non-clinical elements of it, could become one of the most important and valuable parts of the primary care team as they will be critical as neighbourhoods develop.

Ben Gowland is director and principal consultant at Ockham Healthcare, a think tank and consultancy. He was an NHS chief executive for eight years and has also been a director of Croydon Health Services NHS Trust. He established Nene Commissioning, first as a PBC organisation and then as one of the largest CCGs.