Dr Sean Phillips

Research Fellow, Health and Social Care Unit Read Full Bio

Robert Ede

Head of Health and Social Care Read Full Bio

Dr David Landau

Senior Fellow Read Full Bio

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At Your Service

Mar 4, 2022

A proposal to reform general practice and enable digital healthcare at scale

General practice has always been the foundation and gateway to the NHS. However the problems are mounting up: a stretched and increasingly burnt-out workforce, no systematic reporting or analysis of activity and demand, fragmentation with secondary care, and confusing and dated contracting and reimbursement mechanisms. The status quo is increasingly unacceptable to both patients and GPs. There is now a consensus that changes are needed, including to the small-scale independent contractor model, to ensure that primary care can thrive in the future.

Policy Exchange has set out a pragmatic proposal for reform. Addressing issues around integration, workforce, digital transformation and scaled provision, we argue that a new model of general practice is required to better meet the needs of patients and the taxpayer – so it feels increasingly at their service.

“There is now a clear rationale to modernise primary care. The nature of general practice has fundamentally changed over the last decade; many of my colleagues are now seeking varied portfolio careers rather than going down the traditional partner route. The expectations of patients have also evolved and now diverged; some valuing speed and convenience and others, often with more complex needs, requiring time and a sense of continuity to their NHS experience. The challenge is to bring forward reforms which can deliver against these different objectives, whilst making the most of digital technologies to redesign pathways.

“The report offers a credible roadmap to deliver this transformation. From bringing diagnostics into community settings, moving to new payment mechanisms, and introducing a package to retain and motivate our current workforce, Policy Exchange have set out a lot of innovative and implementable ideas that we should welcome.”

Dr Harpreet Sood

General Practitioner in London and Non-Executive Director, Health Education England

“The last few years have been particularly brutal for GP services. We know there aren’t enough GPs and the workforce we do have has been stretched to the limit. 

At the same time hundreds of thousands of patients have contacted us about their struggles to get the care they need. Millions more have been left confused and frustrated by the rapid changes to how care is delivered in recent years.

Reforming access to GP services in such a context is always going to be tough and it needs bold ideas, like those in this report, to kick off the conversation. The recommendations on continuity of care, recruitment and retention, and the introduction of ‘NHS Gateway’ are particularly welcome. It is now for the NHS and Government to work these through with both clinical staff and patients, and then resource them for the long-term. 

GP services have changed fundamentally. We need to embrace what was good about the traditional family doctor model and merge it with new possibilities to deliver a service that is convenient, reliable and sustainable for the future.”

Louise Ansari

National Director, Healthwatch England

“This report should stimulate a lively debate about the future of general practice. Not everyone will agree with its proposals, but there is a need – as this report states – to take the opportunity to rethink how to support patients and staff across general practice so the service model is sustainable amidst rising demand. 

Digital healthcare will have a vital role to play, and whilst virtual wards, the NHS App and a wealth of high-quality solutions are already in use across the NHS today, there is an urgent need to improve the overall infrastructure. This report contains a series of excellent suggestions which I am sure will contribute to the thinking in NHS England’s Transformation Directorate as they look to streamline reimbursement and regulation and to accelerate the use of data.”

Dame Barbara Hakin

Chair, HealthTech Alliance; Former Deputy Chief Executive, NHS England

“This is a timely and persuasive report from Policy Exchange.  Back in 2017, the House of Lords committee on the Long-term Sustainability of the NHS which I chaired called for radical change in the design of services: the traditional small business model of GP services is no longer fit for purpose; professions need to be brought closer together; and the Government needs to go much further to enable the introduction of new technologies to deliver improved care in the surgery and the patient’s home. Today, the case for reform is even stronger.”

Lord Patel, KT FMedSci FRSE

Crossbench Peer, House of Lords; President of the Royal College of Obstetricians and Gynaecologists (1995-1998)

Dr Sean Phillips

Research Fellow, Health and Social Care Unit Read Full Bio

Robert Ede

Head of Health and Social Care Read Full Bio

Dr David Landau

Senior Fellow Read Full Bio

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