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Transforming general practice:
Setting the context
Dr Rebecca Rosen
Senior Fellow
The Nuffield Trust
May 15th 2013

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Multiple drivers of demand
Lack of access
to social care
New
medical
technologies
Aging
populations
Rising patient
expectations
Rising
prevalence of
chronic disease
New providers/
supply induced
demand
Primary
care

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Relentless rise in number of GP consultations

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Changes in workforce and working practices
Key findings from M&E survey
of GPs 2012.
Majority work 8 – 9 sessions/week
If working 2 sessions/day, > 10hrs
Believe quality remains high but 
workload is challenging this
Workload  due to admin, QOF,
LTCs and exceeding appt times
Many believe that more capacity
would help to  quality/  burnout
Concerns expressed about ability
to recruit GPs in future
Many report changing skill mix in
response to increasing demand

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The Primary Care Paradox....
‘... a paradoxical situation: the tension
between the relative weakness and un-
attractiveness of this level of care versus the
intention to assign critical strategic functions
to it’
From:Primary Care In The Driver’s Seat? Saltman, Rico and Boerma (eds) 2006

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Primary care ‘fit for the future’
Attributes
• Comprehensive
• Patient-centred
• Co-ordinated
• Continuous if required
• Accessible
• Safe and High Quality
• Population focused
•Adapted from Agency for Healthcare
Research and Quality 2013
Sustainability
• Financial
• Workforce
• Public trust
• Fit with wider health system

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Mechanisms for change
• Innovation from within general practice
• Extended scope and scale of primary and community based care
• Payment systems and contracting arrangements
• CCG initiatives to commission new services from primary care
• Acute sector innovation
• Hospitals setting up primary care services and integrated systems
• Regulatory drivers of change
• Competition rules driving CCGs into competitive procurements
• New technology / information technology
• Creating opportunities for new types of (rural) clinical encounter

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How can new models of general practice
achieve these design principles?
Two broad organisational arrangements emerging for GP:
• Large partnerships
• Networks
Common challenges, including
• Financial constraints
• Uncertain regulatory context
• Workforce pressures
• New interface with commissioners
New opportunities, including
• Clinical commissioning driving collaboration between practices
• Policy focus on Integrated care
• Changing expectations of general practitioners

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Hostile policy context, no clear view of role
of primary care in national health system

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