Five-year deal to expand GP services and kick start NHS Long Term Plan implementation

A new five-year contract for general practice across England will see billions of extra investment for improved access to family doctors, expanded services at local practices and longer appointments for patients who need them.

The deal – the biggest reform to GP services in fifteen years – is due to be approved by NHS England today (Thursday). NHS England chief executive Simon Stevens said it is the first major pillar implementing the NHS Long Term Plan, coming just three weeks after the Plan was published.

NHS England will fund an army of 20,000 more staff to help GP practices work together as part of a local ‘primary care network’. The new recruits – pharmacists, physios, paramedics, physician associates and social prescribing link workers – will free up GPs to spend more time with patients who need them, most as well ensuring patients have access to a wide range of services at their local practice.

This builds on the increase of 5,000 extra practice staff working with GPs over the past four years. Core funding increases will also support more practice nurses and GPs, with the number of young doctors choosing to train as GPs now at a record high.

Patient access will continue to improve, including the introduction of digital appointments, backed by a new patient right to web and video consultations by 2021.

This builds on the progress which saw evening and weekend appointments made available across the country in December, three months ahead of schedule, meaning an extra nine million are available at more convenient times.

It means GP practices will be able to drive further action on killer conditions such as cancer and heart disease as well as doing more to tackle obesity, diabetes and mental ill health, and support older people at home and in care homes.

Simon Stevens said: “This five-year deal unarguably represents the biggest boost to primary care in more than fifteen years, giving patients more convenient services at their local GP surgery while breaking down the divide between family doctors and community health services. It provides the practical foundation for the big service improvements in the NHS Long Term Plan. Patients across England – in towns, villages and cities – will all begin to see the benefits, beginning this year. And it allows us to keep all that’s best about British general practice while future-proofing it for the decade ahead.”

The NHS Long Term Plan will see funding for primary medical and community care increase as a share of the NHS budget for the first time in the health service’s 70-year history, with an extra £4.5 billion invested by 2023.

The new contract will help join-up care, with neighbouring practices, big and small working in multi-disciplinary teams with other community services. That will particularly benefit older people living with frailty and others with long term and complex conditions.

The deal also sets out specific changes to provide dedicated support for care home residents, tackle inequalities in care, significantly improve prescribing safety and medication, the management of diabetes, and end-of-life care.

Half a century after nurses became a core part of general practice in the contract deal of 1966, this one will mean that thousands of pharmacists, physiotherapists, paramedics and social prescribers will all also now become a core part of local primary care teams.

Having the new workforce will allow general practitioners to focus on the sickest patients and will in time allow them to provide longer appointments to people who need one.

Within five years, over 2.5 million more people will benefit from social prescribing, a personal health budget, and new support for managing their own health and care.

The NHS Long Term Plan sets out how Primary Care Networks will join up the delivery of urgent care in the community. This will be included in part of a new £300 million Fund by 2023 for networks to make faster progress. It means general practice will benefit from the impact their work has in reducing avoidable A&E attendances, admissions and delayed discharge, and from reducing avoidable outpatient visits and improvements in prescribing through medication reviews.

Ian Dodge, National Director for Strategy and Innovation at NHS England, who led discussions with the BMA, said: “General practice is the bedrock of the NHS, and the NHS needs general practice to survive and thrive. Through this comprehensive deal, the BMA and NHS England have sought to solve the big problems that general practice faces, and make it possible to expand services for patients.

“Having a Long Term Plan has allowed us to come up with a five-year funding deal for primary care, for the first time in NHS history. And it is also a good deal for taxpayers, with money going directly into extra staff and services.”

Dr Nikki Kanani, a GP and NHS England’s Acting Medical Director for Primary Care, added: “This Contract gives five-year funding clarity and certainty for practices while giving patients improved services. Primary medical and community care resources will increase by £4.5 billion by 2023-24 and rise as a share of the overall NHS budget. And this agreement confirms how much of this new investment will stabilise and transform primary care through general practice and the evolution of Primary Care Networks. It’s a game changer and signals the start of a new era for general practice.”

Among the many other measures in the Contract are:

  • Establishing primary care networks across the whole country by July 2019, backed by £1.8 billion of funding by 2023.
  • A new £300 million Fund by 2023 will include networks making faster progress in achieving the outcomes described in the NHS Long Term Plan. This will mean that general practice will benefit from the impact their work has in reducing avoidable A&E attendances, admissions and delayed discharge, and from reducing avoidable outpatient visits and improvements in prescribing through medication reviews.
  • From April this year, clinically-proven improvements in the management of diabetes, blood pressure control and cervical screening, through reforms to the GP Quality and Outcomes Framework, with further changes in the pipeline on heart failure, asthma, COPD, and mental health.
  • From April this year, new support for quality improvement, starting with prescribing safety and end-of-life care.
  • Additional funding of IT which will allows both patients and practices to benefit from the latest digital technologies. All patients will have the right to digital-first primary care, including web and video consultations in 2021. They will also be able to order repeat prescriptions electronically from April 2019 and have digital access to their full records from 2020.
  • From April this year, direct booking of calls from NHS 111 into GP surgeries.
  • Protecting the principle that general practice remains free on the NHS, through a new ban on advertising or hosting private GP services.
  • Ensuring public confidence to invest in the GP partnership model, through increased transparency of NHS earnings, and a new mechanism to protect against unexpectedly high or low earnings.
  • Solving the indemnity funding crisis, through a new NHS Resolution Clinical Negligence Scheme for general practice to start from April 2019. All general practice will be covered, including out of hours and all staff groups as well as new recruits. It means they won’t pay indemnity cover and they will be protected from future inflated indemnity costs.