Andrew Haldenby is director of the public services think tank Reform.
Ministers have dug in on the junior doctors strike and are right to do so. The BMA has made the fight one of principle, basically about whether the NHS should change at all. David Cameron has found a new voice on NHS reform in this Parliament, arguing that the service should change in return for the extra resources that he has provided for it. Both sides are on a collision course. While it is hard to see a way out of the impasse, that does not mean that the Government should back down.
Hospitals will always dominate the public debate on healthcare but general practice is just as much in need of radical change. New research published today by the Reform think tank shows that GPs remain in large part a cottage industry, unmodernised and unable to provide the access that citizens require. Size matters because, as the Care Quality Commission has shown, larger practices offer higher quality care. On latest figures, the average size of an “outstanding” practice (as rated by the CQC) was seven or eight GPs. The corresponding figure for “inadequate” practices was three or four. Yet around 60 per cent of practices have fewer than four GP partners. Only six per cent have ten or more. Meanwhile general practice remains in a comparative Stone Age, with only seven per cent of appointments booked online, for example.
The future is the pioneering GP “super-practices” which have emerged as a reaction to these problems. The average GP has 7,500 patients on their list. Super-practices such as Modality, based in Birmingham, have over 100,000 patients and that figure is rising fast. These organisations are proving able to develop the NHS at speed. Lakeside Healthcare, a Northamptonshire-based super-practice, has provided a new urgent care centre covering 200,000 people. Its appointments are one-third of the cost of an A&E visit.
Taurus Healthcare, in Herefordshire, has refuted the argument, made by the BMA and others, that the public do not want seven-day access. It just takes time for people to react to the new offer. For Taurus, the proportion of weekend appointments taken up by patients rose from 40 per cent in January 2015 to 80 per cent in December 2015.
These changes can and should go much further. At present GPs take around two-thirds of the 370 million appointments at their surgeries each year. Survey results suggest that around half of these can be taken by other practice staff. That would ease GPs workload, enable them to focus on those in greatest need and free them from the tyranny of the ten minute appointment.
All of this vision of change is entirely in line with the vision of a reformed NHS that the Government has set out. To achieve it, however, ministers should alter their position in two areas. The first is the ban on any changes to the number of commissioning bodies in the NHS (i.e. the organisations that buy care on behalf of patients from hospitals and GPs). Jeremy Hunt has rightly sought to move the health policy towards quality and safety and away from bureaucratic tinkering that leaves the public cold (no more “top down reorganisations”). Still, the strange mixture of bodies that commission care are not only fragmented but also, in many cases, too small to hold super-practices to account. Ministers should reduce the number of commissioners, as the Blair Government did before them.
The second is the Government’s wish to recruit and retain 5,000 extra GPs. That is a sticking plaster which will not solve the underlying, deep problems of GP services. It may be another bone of contention with the BMA but the future of primary care is far superior technology and teams of different kinds of clinicians and support staff.
It may not always feel like it to them, but ministers are winning the argument on NHS change. They should push on in general practice as well as in hospitals.