General practice is under tremendous pressure right now. Recent years have seen a growth in the volume and complexity of our work alongside rising costs. Yet the growth in funding and workforce have not kept pace with the demands or growth elsewhere in the NHS. The General Practice Forward View presents a wide ranging package of national actions aimed at increasing funding, growing the workforce, improving infrastructure and reducing workload.
This includes £127m of practical support over the next five years to help practices manage their workload better through releasing time for care. The new General Practice Development Programme, supported by training for staff, support for practice managers and investment in online consultation systems will make general practice more sustainable and improve care for patients. It will have immediate effects through making workload more sustainable and releasing time for staff to spend with the patients who need it most. It will also have longer terms benefits through strengthening collaboration between practices and other organisations in the health and care system, establishing a renewed focus on patient benefit within federations, and building capacity and capability for service improvement.
The programme responds to important needs and opportunities which are not the province of national policy but can only be addressed at local level and within practices themselves. It addresses needs identified the Making Time in General Practice report, commissioned by NHS England, and extensive engagement with practices across England. It focuses on proven service innovations shared by practices throughout the country, particularly through the Prime Minister’s GP Access Fund. And it draws on several years of NHS experience in supporting GP practices to innovate and improve services, and the evidence about the approaches that work.
The plans for the programme are the result of extensive discussion over recent months with professional leaders and a significant number of experts in improvement, leadership development and management support. In particular, NHS England’s sustainable improvement team have brought their experience in supporting the leaders of 2,500 GP practices in over 100 federations participating in the Prime Minister’s GP Access Fund, and of designing internationally recognised learn-while-doing programmes for primary care over a number of years.
The programme has a national reference group drawn from professional bodies, practices, patient groups, commissioners and improvement bodies. They are providing advice and support for the design and delivery of the programme.
The programme is not about NHS England telling practices what to do and then expecting them to be successful in doing it. Rather, it will share what other practices are already finding helpful, and then brings national expertise to local groups to support the process of planning and implementing practical change as rapidly, safely and sustainably as possible.
The delivery team
The sustainable improvement team at NHS England will be the lead provider for this programme, working with its primary care improvement faculty. These are experienced leaders and coaches of improvement, most with a background in general practice or commissioning. They are schooled in improvement science, leadership development, coaching philosophies and social movement paradigms of change. They have a deep understanding of general practice, and adopt a flexible approach to real-world problem solving and knowledge transfer, blending teaching, coaching and facilitation.
One of the aims of this programme is to leave a legacy of increased capacity and capacity for highly skilled and credible improvement and leadership development in primary care. At present, there are very few people anywhere in the world with the requisite background, knowledge and skills to fulfill the delivery needs of this programme. Therefore, one of the tasks of the sustainable improvement team will be to grow its faculty by at least 100 people over the three years of the programme. The apprenticeship approach used to recruit and quality assure new faculty members means that this will have a direct delivery benefit, as well as leaving a legacy for the NHS in the future.
The sustainable improvement team also subcontract with other providers of specialist input, such as experts in Lean, measurement, workforce redesign, board coaching and project management. Existing relationships include both small and large organisations. Where CCGs and practices are receiving consultancy and development support from other organisations, such as CSUs, AHSNs and others, the delivery of this programme will aligned with that.