Radical overhaul of GP Forward View – and billions more investment – needed to protect general practice and patient safety, says RCGP

The GP Forward View – launched by NHS England as a ‘lifeline’ for general practice two years ago – needs a major overhaul and a substantial cash injection of an extra £2.5bn a year on top of the funding already pledged, to protect patient safety and guarantee the future of the family doctor service, says the Royal College of GPs today.

In its second Annual Assessment of the GP Forward View, the College highlights areas where the five-year plan is falling short, particularly in the efforts to boost the GP workforce by 5,000 by 2020. Since the GP Forward View was launched in April 2016, the GP workforce has actually fallen by over 1,000 full-time equivalent GPs, according to official figures, meaning that more than 6,000 are now needed to meet the Government’s target.

While the promised funding of £2.4bn extra a year by 2020 is on track to be delivered, the College’s report – which includes the results of a survey of 1,216 GPs – says that GPs are just not feeling the impact of this extra investment on the frontline of patient care.

The College is now calling on NHS England for an urgent overhaul of the plans, saying: “There were not enough doctors working in general practice when the GP Forward View was published. Now, there are even fewer. This is a fundamental problem and while it persists many of the other commitments in the GP Forward View cannot achieve the impact they were designed to deliver.

“Without enough GPs, excessive workload remains a major problem, exacerbating the pressures that are causing doctors to leave the profession.”

The College says that while existing investment commitments are welcome and the amounts promised are being delivered, general practice has become even more challenging in the past two years and that additional funding is now needed, on top of the £2.4bn a year extra that was originally pledged.

The College calculates that by 2020/21, investment in general practice could reduce to 8.9% of NHS health spend – which would be lower than the year before the GP Forward View was launched.

Since the GP Forward View was launched, Prime Minister Theresa May announced £20bn extra a year in real terms for the NHS by 2023. The RCGP is now calling for £2.5bn extra a year to be ploughed into general practice services by 2020/21, bringing investment up to £14.5bn a year.

This would constitute 11% of the overall NHS budget, bringing funding in line with what it was in 2005, and reinstating the College’s calls first made in its Put patients first: Back general practice campaign, launched in 2013, which led to the GP Forward View being developed.

Despite its critical assessment, the College acknowledges that there are several key areas where progress is being made, including:

  • promises of a state-backed medical indemnity for GPs in England, announced by the previous Health Secretary Jeremy Hunt at the RCGP Annual Conference last year
  • more GPs in training than ever before
  • the establishment of the NHS GP health service, which is highly rated by its users
  • the introduction of practice-based pharmacists is on track to exceed its target of 1,500 by 2020/21; and
  • a less arduous and costly process for returning to work after a career break or period working abroad

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: “We are not turning our back on the GP Forward View – it remains the most constructive, indeed only, solution to tackling the intense resource and workforce pressures facing general practice, and it is making good strides in some areas.

“But it needs an urgent overhaul to address the pledges that are not progressing fast enough, particularly around retaining our existing workforce and reducing our workload; and to recognise the changing landscape of NHS funding, which now includes a promise of £20bn extra a year by 2023.

“General practice is the lifeblood of the NHS. GPs and our teams make the vast majority of NHS patient contacts for little over 9% of the overall budget, and in doing so we alleviate pressures in hospitals where care is costlier.

“The new Secretary of State recently identified Workforce and Prevention as his top priorities. If he is serious about tackling the workforce crisis and keeping patients out of hospital, it is essential that the government invests properly in general practice.

“Of course, we need to work differently in general practice, but GPs and our teams across the country are struggling – and that makes innovation almost impossible. Our workload is constantly escalating, both in volume and complexity, and we are constantly firefighting, trying to keep up with demand, without enough resources to do so.

“It is now time for us to go above and beyond the original GP Forward View. The vital importance of general practice must be recognised as decision-makers draw up plans as to how to spend the new money that the Prime Minister has promised for the NHS. We believe that at least £14.5bn is necessary – an extra £2.5bn a year on top of what has been promised in the GP Forward View.

“Only then will we be able to continue to guarantee the safe care our patients need and deserve, close to home where they want it most, away from hospitals where care is more expensive.

“Investing in general practice truly is investing in patient care right across the health service.”