Current model of general practice cannot survive, says primary care minister

From GP magazine David Millett on the 13 January 2016

Speaking at a House of Commons health select committee meeting on Tuesday, Mr Burt said the current model of general practice could not last because ‘nothing survives these days’ and mounting pressure on GPs is causing some to ‘work themselves to death’ in the current system.

‘Doctors want a different sort of life and a different way to carry out their practice,’ he said. ‘We have to respond to that. Doctors worked themselves to death and there’s no going back to that. We need to respond with a different strategy, [but] we won’t say one model is better than the rest.’

When directly asked by MPs whether the current GP model could survive, he said: ‘Nothing survives these days – it’s all change. It’s a question of what is best. A young person going to university now will be entering general practice in about 10 to 11 years’ time, and the world will be very different by then.

GP contract model

‘We need to plan for 2030 and beyond. I’ve met doctors who feel burdened by the structure they have now, they’ve worked very hard. Both attitudes are very real, those who have great excitement doing what they’re doing now and those who feel they’re on a treadmill they can’t get off. So we need to look at what can we change to improve life for them.’

Ministers also admitted that the government’s target to deliver an extra 5,000 GPs in England by 2020 could slip because it depends on filling all available trainee places.

The government has admitted that this key election pledge would be met by recruiting 4,000 new GP trainees, and 1,000 ‘through return to practice and better retention’ of existing GPs.

Also speaking at the meeting, Ben Dyson, director of the NHS Group at the DH, said to meet the target ‘we need to increase further the uptake of specialty training’.

He went on to say that if ‘all training places available’ between now and 2020 were filled, the government would recruit the 4,000 trainees it needs.

GP recruitment

But 2015 saw one in nine (11%) trainee places left open after three full recruitment rounds, with some areas failing to fill even two thirds of available places.

When quizzed by committee chairwoman – former GP Dr Sarah Wollaston – about whether the target could be met on the ‘current trajectory of GP recruitment’ he said: ‘I’m not sure I can give an answer.

‘What I do know is we’ve increased the number taking specialty training and we need to increase it further. Those places will be available, but we need to fill them. If we successfully fill those places we will have 4,000 more GPs working by 2020.’

Mr Burt also praised the CQC’s chief inspector of primary care Professor Steve Field for ‘defending himself extremely well’ against the RCGP and BMA in a previous health committee meeting, during which he said he was ‘ashamed’ of his profession. This culminated in both organisations calling for him to apologise and resign, respectively.

He added that the CQC has done well in rooting out poorly-performing GP practices.

‘The CQC regime… has uncovered things that weren’t right and needed to be changed,’ he said, before going on to explain that the regulator should change how it works from now on.

‘The first-time look should not necessarily be the same as the second-time look,’ said Mr Burt. ‘Clearly, we don’t need to reinvent the wheel on a practice we know is doing well. I see the inspection process developing under the CQC, responding to pressures and trying to make the burden on practices as easy as possible.

90% of practices revisited by CQC demonstrate improvement, so that’s the sort of regime we want to see.’


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