Government must restore doctor-patient relationship to the heart of general practice, say MPs

• Crisis in general practice is risking patient safety

MPs accuse the government and NHS leaders of failing to heed the evidence on the importance of continuity of care, hastening the decline of a uniquely important relationship between a GP and their patients, in the midst of an acute and growing shortage of GPs.

The wide-ranging report on the future of general practice urges Ministers and NHS England to acknowledge a crisis in general practice and set out what steps they are taking to protect patient safety.

MPs warn that seeing your GP should not be like phoning a call centre or ‘booking an Uber driver’ never to be seen again and note that care based on a doctor-patient relationship is essential for patient safety and patient experience. The report sets out steps to reverse the decline in the continuity of care, making it an explicit national priority with a new measure requiring GP practices to report on continuity of care by 2024. However, this will be more difficult to achieve unless the workforce crisis is also addressed. The Committee finds it “unacceptable” that one of the defining standards of general practice has been allowed to erode. MPs also urge NHS England to champion the ‘personal list’ model and re-implement it in the GP contract from 2030.

Health and Social Care Committee member Rachael Maskell said:

“Our inquiry has heard time and again the benefits of continuity of care to a patient with evidence linking it to reduced mortality and emergency admissions. Yet that important relationship between a GP and their patients is in decline. We find it unacceptable that this, one of the defining standards of general practice, has been allowed to erode and our report today sets out a series of measures to reverse that decline.

“Seeing your GP should not be as random as booking an Uber with a driver you’re unlikely to see again.

“The wider picture shows general practice as a profession in crisis, with doctors demoralised and overworked, the numbers recruited not matching those heading for the door. A reluctance by Government and NHS England to acknowledge this crisis cannot continue and Ministers must set out how they intend to protect patient safety in the short term.”

ENDS

Action that should be taken now by the Government and NHS England:

• Government and NHS England must acknowledge the decline in continuity of care in recent years and make it an explicit national priority to reverse this decline.
• NHS England should introduce a national measure of continuity of care to be reported by all GP practices by 2024.
• NHS England should re-implement personal lists in the GP contract from 2030 onwards.
• 1,000 additional GP training places each year should be created with Government funding.
• Government and NHS England should be clear in acknowledging a crisis in general practice and set out steps they are taking in response in the short term to protect patient safety, improve access and reduce GP workloads.

• Urgent work needs to be done to stop a bidding war for the services of locums.

Please see attached Report: The future of general practice for a full list of conclusions and recommendations

Unsustainable pressures:

The report finds that unsustainable pressures on general practice are putting safety at risk with patients facing unacceptably poor experiences. A reluctance by Government and NHS England to acknowledge the crisis has left the Committee unconvinced there is preparation to tackle problems with the speed required.

Evidence demonstrated that GPs were leaving a demoralised profession almost as fast as they could be recruited with patients increasingly dissatisfied with worsening access to care. Growing demands on GPs and a decline in numbers practicing was leading to doctors working harder and facing burnout.

On recruitment, MPs say is it “disappointing” that the Government would not meet its target to recruit 6,000 additional GPs by 2024 and urge Ministers to fund an additional 1,000 training places each year.

The Government's decision to introduce an additional two-week wait target for GP appointments, though well-intentioned, does not address the fundamental capacity problem causing poor GP access. MPs urged the Government to examine the possibility of limiting a GP’s list size of patients, a figure that would be reduced over five years as more GPs are recruited.

Recent changes by Government and NHS England, such as the creation of Primary Care Networks, have failed to make any meaningful impact on the future sustainability of general practice, says the report.

Continuity of care and the ‘personal list’ model:

Evidence showed that that that higher continuity of care was linked to lower use of emergency services with one Norwegian study showing a clear association between continuity and ‘hard end points’ including reduced mortality and lower emergency hospital admissions.

The Committee heard that the ‘personal list’ system where individual GPs are assigned a list of patients and deliver the majority of their care were the gold standard of continuity of care, enabling practitioners to be more efficient and reduce workload pressures. MPs recommend NHS England sets an ambition for 80% of practices to return to personal list continuity by 2027, in addition to re-implementing the personal list model in the GP contract from 2030.

The report also found regional variation in general practice with areas that are already under significant pressure due to high levels of deprivation, ill health and under-doctoring having these pressures compounded by unfair funding mechanisms that fail to take account of deprivation experienced.

Link to the future of general practice inquiry.