GP Practices and the Five Year Forward View

The NHS Five Year Forward view makes proposals that will significantly affect the services provided by GP practice. What does it entail and how should GP partners and practice managers prepare for the changes that will be required if it is adopted by this or a subsequent administration?

The implementation of the new GP Contract in 2004 and The Health and Social Care Act in 2012, ever-increasing calls from the Treasury to achieve significant efficiency savings and additional internal and external demands have created significant challenges for GP practices in recent years.

These challenges are likely only to increase if the NHS Five Year Forward View, a blueprint devised by NHS England chief executive Simon Stevens which sets out the sweeping overhaul that it intends to implement between 2015 and 2020, is adopted by this or the next government. The stated aim of this reconstruction of the service (which will require an additional £8bn in funding) is to reduce the pressures that hospitals and practices are facing and to offer a better standard of care to patients.

How Will the Five Year Forward View Affect GP Practices?

The principle measures that are likely to affect GP practice are:

• a significant move of NHS funding from hospitals into non-hospital services, including GP practices
• the need for better coordination between emergency care services such as hospital Accident and Emergency, GP out of hours services and the NHS 111 advice line
• the removal of the prohibition on GPs being employed by hospitals
• a concerted attack on chronic health problems such as obesity, smoking and the abuse of alcohol.

One of the blueprint’s aspirations is that GP surgeries will be transformed into pocket-sized hospitals where patients will be provided with minor, routine surgical procedures and those types of diagnostic tests that have historically been within the sole domain of hospitals, such as ultrasound and x-ray in the short term and eventually CT and MRI scans.

These changes clearly carry far-reaching implications for GP practices and the need for them to be properly prepared, in the light of the fact that the implementation of the blueprint is scheduled to commence in 2015, is a matter that should be afforded appropriate consideration.

Meeting the Challenge

Practitioners and practice managers will need to take proactive steps to ensure that they are able to meet the challenges presented by the Five Year Forward View if they are to assimilate themselves into the envisaged schema. These steps are likely to involve:

• A structure for involving the entire practice team in understanding the implications and preparing for the implementation of the blueprint. The framework for seeking the support of the team for the changes they will be required to make should be founded upon the premise that the key to success will be through working through the changes as a well co-ordinated team, working in close, mutual co-operation to meet the challenges ahead

• Ensuring that partners, practitioners, nursing staff and support workers are thoroughly trained in any new disciplines that are required of them

• The implementation of an enhanced supervision policy, at least during the initial phase of the transfer of services

• A revision of the practice budget in the light of the cost of providing the additional services, the funding received and the demands of the staff for enhanced rewards in return for providing additional and/or more demanding services or those that require supplemental professional qualifications ad/or training

• Achieving the right balance between providing a response to the presenting medical complaints of patients (whether acute or chronic) and preventative care and, so far as it may be required, instigating the necessary recruitment programme to ensure that preventative care can be provided through the most cost-effective model

• A clear framework for the co-ordination of emergency care with A & E, the 111 advice line and other associated providers of urgent services. The plan clearly envisages a greater concentration on teamwork between the respective providers

• A strategy for communicating the new regime to patients with a view to reassuring them that the standards of care that they will receive will not diminish following the transfer of service provider from hospital to the practice and that their GP will continue to act as their advocate within the new framework.

Summary

The stated aim of the Five Year Forward View is to reduce pressures on hospitals and GP practices and deliver improved patient care. Whether this aspiration is a realistic one is open to debate as, if the blueprint is endorsed by this or a subsequent government, it will introduce ancillary pressures of its own, not least as there is no guarantee that any government will accede to the demand for an additional £8bn of funding and the possibility that the proposed overhaul of services will be adopted – but not the funding request – should not be discounted.

The extent to which, if at all, GP practices start to prepare for the implementation of the blueprint should, at the very least, be an item for the agenda of the next practice meeting.

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