Underwhelming manifesto promises for primary care

With such a dark cloud hanging over general practice at the moment, any potential change, even a new government, brings hope that things might improve in future. So what are the different political parties promising? And how might things change after the 4 July?

Unfortunately, the manifestos are, at best, underwhelming when it comes to general practice. None explicitly recognise the current underfunding of the service or the contractual dispute. The only concrete promise of increased funding comes from the Green party who would increase the allocation of funding to primary medical care ‘with additional annual spending reaching £1.5bn by 2030’. 

Unfortunately, unless the Greens get in, the current funding of general practice is not going to be a priority for the next government. 

Instead, most of the parties want to promise better access. Labour will ‘guarantee a face to face appointment for those who want one’ and ‘deliver a modern appointment booking system to end the 8am scramble’. The Liberal Democrats will give everyone the ‘right’ to see a GP in 7 days or 24 hours if it is urgent and introduce a ‘universal 24/7 booking system’, and the Greens will give ‘guaranteed rapid access to a GP and same day access in case of urgent need’.

So, whatever happens on the 4 July don’t expect the focus on access to change any time soon. There are some pointers to a focus on continuity, however. Labour promise to ‘bring back the family doctor by incentivising GPs to see the same patient’, and the Lib Dems promise to give ‘everyone 70+ and everyone with long-term health conditions access to a named GP’.

The Conservatives meanwhile (in something of a continuation of what we have seen with the current government) pay virtually no attention to general practice in their manifesto other than the very bland statement that they ‘will modernise NHS primary care services and bring health and care closer to patients’, along with a promise (that will impact very few of the existing 6,500 practices) to ‘build or modernise 250 GP surgeries, focussed on areas of new housing growth’.

Staffing in general practice, when it even features, gets the usual promises. Labour will train ‘thousands more GPs’, and the Lib Dems will increase the number of GPs by 8,000 ‘half by boosting recruitment and half from retaining more experienced GPs’. More usefully, in a nod to removing the restrictions of the ARRS scheme, the Lib Dems promise to ‘remove top-down bureaucracy to let practices hire the staff they need and invest in training’.

Nearly all the parties want to expand the role of pharmacies. Labour will ‘introduce a community pharmacist prescribing service’, the Conservatives will ‘expand Pharmacy First’ to include more conditions, and the Lib Dems will give ‘more prescribing rights to pharmacists’. So whoever wins expect more of a shift in this direction.

Labour’s big idea is to move to a ‘neighbourhood health service, with care delivered in local communities to spot problems earlier’. They do say that to achieve this they must (‘over time’) shift resources to primary care and community services. They believe the ‘principle of integrating health and care services will improve the treatment patients receive’, and state that they will ‘trial neighbourhood health centres’ bringing different clinicians (including GPs) under one roof.

While this is worryingly reminiscent of the whole Darzi centre experience of 20 years ago, this most likely means an ongoing development of PCNs and a stronger push to closer working between primary and community care. So if Labour do get in, while there may be some rebadging, the overall shift towards integration that we have seen in recent years will continue, and place-based working could become even more important.

Given the parlous state of current general practice this election was an opportunity for the competing political parties to use promises about the service to win favour with potential voters. But the size of the waiting lists and the length of emergency care waits, along with the inability to access an NHS dentist, are seen as bigger issues by nearly all the parties. 

For general practice it means it is not seen as a problem to be solved, but rather as part of the solution to bigger problems. The focus is firmly on shifting care closer to home, to ease secondary care pressures, and the worry is that may mean imposing significant change onto general practice so that is potentially something we can expect.

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.