General Practice: A call to action

NHS England’s Deputy Medical Director, Mike Bewick, calls for GPs to help shape the future of primary care:

As an experienced GP who has worked in both acute and primary care in Cumbria for over 20 years, I know too well the pressures facing colleagues across the country.

GPs see over one million people every working day, the average patient visits their doctor just over five times a year, and the demand for services across the system, including general practice and wider primary care, continues to rise.

The number of people aged 65 or older is expected to be around 16 million in 2030 and an ageing population means large increases in consultations for older people.  In the ten years up to 2009, there was a 95 per cent growth in the consultation rate for those aged between 85 to 89 years and this number is set to rise.

The number of those with multiple long term conditions is set to grow to 2.9 million in 2018 and the number of older people likely to require care is predicted to rise by over 60 per cent by 2030.  Set against this backdrop, growing dissatisfaction with access to services, increasing pressure on budgets and challenges with recruitment, retention and inequity in the distribution of the workforce means general practice and wider primary care must change.

We know that general practice wants and needs to transform the way it provides services to address these challenges and at the beginning of August we launched Improving General Practice – A Call To Action to help stimulate debate amongst GP practices, area teams, CCGs, health and wellbeing boards and other community partners as to how best to develop general practice services fit for the future.

General practice colleagues and clinical commissioning groups (CCGs) are already looking at how they can transform the way they provide services for the benefit of patients, and the questions in the ‘Call To Action’ are designed to support existing examples of local action and to stimulate similar approaches across the whole country.

NHS England wants general practice to play a stronger role in the co-ordination of care, particularly for people with long term conditions and complex health and care problems and respond to the challenge of reducing premature mortality.

We believe that general practice has the skills and expertise to best design and deliver more holistic care that addresses people’s physical health needs, mental health needs and social care needs in the round.

GP-led integrated out-of-hospital services can reduce avoidable emergency admissions and A&E attendances, prevent ill-health and lead to more timely diagnosis.  A stronger role for general practice will enable us to make the changes necessary to deliver better health outcomes, more personalised care, excellent patient experience and the most efficient possible use of NHS resources.

This is not about reinventing the wheel.  There is widespread agreement that in supporting reform of primary care services, NHS England must build on the many strengths of general practice such as its system of registered patient lists, its generalist skills and its central role in the management of long term conditions.

We are also developing a strategic approach to commissioning primary dental, pharmacy and eye care services and will carry out separate engagement exercises in due course.

We are currently engaging with local communities, clinicians and stakeholders about the best possible way to develop general practice for the future. But, we need your views and I encourage you to get involved.

Dr Mike Bewick is Deputy Medical Director at NHS England.


  1. M. Cole says:

    High ideals, high expectations & no doubt about it a real benefits if achieved.

    However, from a patient’s perspective, the foundations are crumbling & need major remedial work before you build on sand.

    Appointments locally to me are a joke. If you want to see a GP you have to divulge your symptoms in detail to a receptionist. They make an unqualified diagnosis & determine when you can be seen.

    If you question that you’re asked “is it an ABSOLUTE emergency” in an attempt to throw you off track.

    Pardon me, but if something was emphasised as that urgent I’d be dialling 999.

    If you ask to see a particular GP you get offered an appoint at a MINIMUM of one calendar month later. Again to deter you from doing anything other than what the practice rules say.

    Some problems have now been designated under “a new protocol” as requiring a visit to the Practice Nurse first, then maybe a Doctor of a a re-visit to collect a prescription. Basically two visits for one problem.

    Where the legality of the consequences of a serious medical problem suffering delayed treatment in this manner would lie is one for the lawyers no doubt.

    Patients are no longer at the centre of many GP Practices, no doubt working overloaded, they are an inconvenience to the working day at best.

    So, as above, before you try to fix everything with amendments, repair the foundations you want to build on, the legal costs may be dire if you don’t.

  2. george coxon says:

    I very much welcome Dr Bewick’s comments here – I’m not a GP however but spend a lot of my time dealing with the plight of older people particularly those with dementia trying to add value to their lives including how we keep them out of hospital. After a long clinical mental health career followed by many years as a senior commissioner I now have a range of roles in various organisations addressing this theme including owning and running care homes, leading work on developing a quality kite mark for improvement across a growing number of residential homes in Devon – we really need to heed the details and figures in Dr Bewick’s powerful presentation (attached to his blog) – essentially re options its comes down to – working together, getting over self interest and funding and power struggles and focusing on what people want, want the need and what they get – incidentally I chaired a large conference at the NEC in Birmingham where Dr Bewick was one of my speakers – what a nice chap !