Hunt promises more investment in general practice in return for seven day access

BMJ 2015; 350 doi: (Published 19 June 2015) Cite this as: BMJ 2015;350:h3380
  1. Gareth Iacobucci
  1. 1The BMJ

England’s health secretary has promised GPs “the biggest opportunity for new investment in a generation” if they commit to his government’s plans for seven day primary care services.

In a speech at a health centre in south London Jeremy Hunt promised to redress historical underinvestment in general practice as part of his “new deal” for the profession.1 But Hunt said the new investment would hinge on GPs embracing plans for seven day services that were currently being piloted across England.2

“New deals have two parties, so I want to be upfront: this is not about change I can deliver on my own,” he said. “If we are to have a new deal I will need your cooperation and support—both in improving the quality and continuity of care for vulnerable patients and delivering better access, seven days a week, for everyone.”

In a wide ranging speech Hunt vowed to tackle the current recruitment and retention crisis in general practice, reiterating his pre-election pledge to train 5000 new GPs and 5000 additional healthcare workers to work in primary care. As part of this target, he announced new plans to invest in 1000 physicians’ associates3 to work in general practice by September 2020 and to allocate £7.5m (€10.5m; $12m) of the government’s £1bn primary care infrastructure fund to help and expand community pharmacy.

He also promised new data on staffing levels across the country to allow the government to focus GP recruitment on the most under-doctored areas and new targeted financial incentives for doctors working in deprived and under-doctored areas.

Trainee doctors will be offered a further year of training in a clinical specialty relevant to primary care, such as paediatrics, psychiatry, and emergency medicine, he added. In addition, the government will seek to introduce more flexibility for GPs who wish to work part time and offer more support to those who wish to return to the profession.

To supplement these measures, Hunt said that the Royal College of General Practitioners and the BMA would lead a national marketing campaign to encourage medical students to choose general practice, by highlighting the ambitious investment plans.

He said that 1000 general practices had already had bids provisionally approved for £190m of investment in premises this year as part of the £1bn infrastructure fund. And as part of a new commitment to assess the quality of primary care services, the government has commissioned the Health Foundation to review all current metrics for measuring performance and collect and publish better outcome driven assessment of the quality of care for different groups of patients.

Alongside this, Hunt announced a £10m programme of support for struggling practices, which would include advice, support, and new business models.

In response to growing fears of burnout in the profession, Hunt added that he had asked NHS England to explore ways to reduce the bureaucractic burden on GPs and to outline solutions this autumn as part of the new deal.

“Even though 90% of all NHS contact takes place via GP consultations, successive governments have undervalued, underinvested, and undermined the vital role it has to play,” he said. “The result has been a profession where many GPs feel overwhelmed by demand and undervalued by the system, unable to give the comprehensive care they want to, and trapped on a daily hamster wheel of 10 minute appointments that lead inexorably to burnout, early retirement, and unfilled vacancies.

“That is why I am keeping my pledge to announce the first steps in a new deal for general practice.”

Hunt insisted that seven day primary care was about “much more than convenience” and said that new models of care “should never be one size fits all.” But he did not specify how the government would treat practices and areas that opted out of seven day working, as occurred with a pilot scheme in North Yorkshire, where doctors decided to curtail it because of a lack of demand from patients.4

He told GPs, “This is the biggest opportunity for new investment in general practice in a generation.

“But in return I will need your help to deliver a profound change in the quality of care we offer patients.”

GPs’ leaders welcomed the health secretary’s public support for GPs but urged the government not to fixate on seven day working and to focus on fully costing and funding the proposals. Maureen Baker, chair of the Royal College of General Practitioners, said, “The secretary of state makes many commitments which, if they come to fruition, will put general practice on a more stable and secure footing for the future and ensure that family doctors can keep pace with rocketing patient demand and increasingly complex caseloads.

“What we need now is a clear and costed plan for turning this into a reality—and a timescale for how quickly this can be delivered.”

Chaand Nagpaul, chair of the BMA’s General Practitioners Committee, said, “To address this crisis in GP recruitment and retention and to re-establish general practice as a profession that is rewarding and appealing, we stand ready to work with the government to move beyond fine rhetoric and bring forward practical solutions that give GPs time and tools they need to stabilise general practice. We need action now, not just aspiration for the future.”


Cite this as: BMJ 2015;350:h3380


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