As 2024 draws to a close, Pulse looks at the big issues in general practice this year, such as Labour’s 10-year plan, the shift from ‘hospital to community’, and the focus on neighbourhood teams
Less than a week into the role of health secretary, Wes Streeting tasked Lord Ara Darzi with an independent investigation into the ‘state of the NHS’. Lord Darzi was given just under two months to research and produce a report that would inform a new 10-year plan to ‘radically reform the NHS.’
The former Labour minister received evidence from the BMA, RCGP and DAUK. The BMA’s submission argued that the lack of GPs and ‘inadequate resource’ are ‘negatively impacting continuity of care.’ Ahead of the Darzi review’s publication, Mr Streeting committed to three strategic shifts for the NHS:
- Moving from ‘analogue to digital;’
- Moving from ‘treatment to prevention;’
- Moving care from ‘hospital to the community.’
When Lord Darzi’s report was released, it confirmed what GPs already knew. They are ‘expected’ to manage and coordinate ‘increasingly complex care’ but without the means to do so. Standard GP contracts are counterproductive as ‘doing the right thing for patients can require doing the wrong thing for GP income.’ Lord Darzi also noted that GP practices have to be on top of their finances as they will not be bailed out in the same way their secondary colleagues might be.
Most pertinent to general practice, the Prime Minister commented on a shift in care from hospital to the community, saying previous governments had tried and failed to do so. He touted the 10-year plan as the moment this changes and the move from a ‘National Health Service into a Neighbourhood Health Service’ begins. First announced in December of 2023, and reiterated in their election manifesto, Labour plans to trial ‘neighbourhood health centres’ as a model of primary care that will ‘save patients’ time, save taxpayers’ money and fix the front door to the NHS.’ There were no further details given by Labour when Pulse inquired about exact details of the neighbourhood hubs.
However, we may already be starting to see signs of what shifting care in the community would look like. In October, Pulse exclusively reported that North West London (NWL) ICB had drawn up ‘first-of-its-kind’ plans to introduce ‘integrated neighbourhood teams’ (INTs) inspired by the Fuller Stocktake. This would see 25 INTs each look after a population of 50,000 to 100,000 residents.
If this rings any bells, it could be because NWL ICB was also the site of the controversial same-day access hubs that were shelved in March following backlash from GPs regarding patient safety, quality of care, and logistics. The £5m that was tied to the hubs was ring-fenced for general practice access, so the implementation of INTs is a way to ensure that money is not lost – even though Pulse has been told that the two are not ‘directly related.’ It is unclear if NWL’s INTs are specifically rooted in the Fuller Stocktake, or are forming part of the ‘trialling’ promised by Labour, now forming part of the 10-year plan.
When the 10-year plan was launched, GPs were encouraged to share ideas for how to ‘fix’ general practice. Though the Government was – again – focused on the ‘hospital to community’ shift via ‘neighbourhood health centres’, other issues appeared more pressing for the professions: workforce and funding. The RCGP called for a new national retention strategy, including ring fenced funding. The BMA demanded that the NHS 10-year plan must also commit to a new GP contract – which besides providing adequate funding, should also end ‘the scandal of doctor joblessness.’ The Government has since committed to producing a ‘refreshed’ NHS workforce plan with a ‘laser-focus’ on boosting GP numbers.
The 10-year plan is set to be published in spring, and the updated workforce plan in the summer. It will be interesting to see what the results bring for general practice: will there be any focus on supporting GP funding and growing the workforce? Or will it be solely focussed on the ‘hospital to community mantra’ and ‘neighbourhood health centres’? In short – will GPs finally be listened to?.
