GPs should be ‘left alone’ to work in ‘high trust’ environment, says review author

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The way to bring about positive change in primary care would be to leave GPs and their teams alone, says the author of a landmark review.

Dr Claire Fuller made the comments to the House of Commons Health and Social Services Committee today during a hearing on the future of general practice.

She told committee chair Jeremy Hunt the government should put more faith in GPs to enable them to succeed.

Dr Fuller said: “The way to drive change in primary care is actually to create teams, give them a clear mandate, create the environment for them to succeed and leave them alone. It’s really about enabling teams to work in a highly reliable environment.

She also suggested that some regions need to consider an alternative to the GP partnership model, which Health Secretary Sajid Javid has expressed support for.

Dr Fuller said: ‘The partnership model works very well where I currently work. I am very much of the opinion that if something is working, don’t mess with it.

She added: “But there are a lot of areas across the country where that’s not the case.” We’ve already talked about the Reverse Care Act this morning and that’s for the areas where I think we need to look at something different because it’s our most vulnerable people who aren’t being served well by the current model. .

Mr Hunt also asked Dr Fuller: “How [do] are we ensuring there is a downward accountability to patients with our primary care structures, not just an upward accountability to NHS England?

“Is this actually possible, without dismantling the millions of targets imposed by NHS England, whether directly in terms of national waiting time targets, or indirectly through things like the QOF system, which GPs must follow like a straitjacket if they are going to be paid for his services? »

Dr Fuller referred to a Kings Fund global literature review from April 2022 on how you bring about change within general primary care.

She said: ‘What it showed, which will come as no surprise to any GP here, was in fact in England more than anywhere else in the world we relied on centralized financial incentives to drive change. And there is very little evidence that actually leads to change, it leads to increased activity but does not necessarily lead to a change in results.

Mr Hunt asked Dr Fuller about individual patient lists, with each patient registered with a specific GP, going further than the Tory’s flagship patient-appointed GP policy, introduced during his tenure as health secretary.

Dr Fuller said: ‘We don’t have enough GPs to work that way.

Earlier this month, Health Secretary Sajid Javid said he would draw up a ‘change plan’ for primary care because the current model is ‘not working’.

In March, Mr Javid backed a report that recommended phasing out the GMS contract by 2030, with the majority of GPs contracted to large-scale providers such as hospital trusts.

A Times report in January that Sajid Javid was planning a review of primary care, which could prompt GPs to join trusts in a model like Wolverhampton’s.

Dr Claire Fuller’s landmark review last month recommended that same-day urgent appointments be handled by ‘single urgent care teams’ in larger populations rather than the city’s own GP practice. patient.

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