General practice is in crisis: here are five possible solutions

General Practice is the foundation stone of the NHS: if it fails, the whole system will fail. That’s the urgent warning in a new BMJ Editorial from CCHSR Co-Director Martin Roland and Sam Everington, Chair of Tower Hamlets Clinical Commissioning Group. In this piece, Roland and Everington point out that, whilst the whole NHS is in crisis, the critically under-funded primary care system is far more vulnerable than the hospital system (hospitals, they argue, are rarely actually allowed to go bust: this is not the case for general practice). If the NHS has a hope of delivering on its ambitious plans for care, primary care needs a fair funding system and, alongside this, hospitals need incentives so they work across the whole population rather than shifting work into primary care without any resource shifting alongside this. So, what should we do? Roland and Everington identify five key solutions.

  1. General practice needs urgent new funding to enable more staff to address the ”increasing workload and burgeoning bureaucracy” of primary care. In particular, more GPs and nurses are urgently required, and creative solutions must be used to find these
  2. New clinical roles should be supported to ease pressure on overworked clinical staff: for example, medical administrative assistants could free up the equivalent of 1400 extra GPs by taking on a good chunk of GPs’ routine paperwork
  3. NHS England must provide crown indemnity for primary care, mirroring that which it provides for hospital doctors: GPs now do much work previously only undertaken by hospital specialists.
  4. Bureaucracy must be reduced: one approach to this would be to change the Care Quality Commission inspection regime so only the bottom 5-10% of practices found to be struggling are revisited within five years.
  5. Hospital consultants’ job plans need to be amended so they can work much more closely with their primary care colleagues. For example, the Choose and Book referral system needs radical reform to cut outpatient attendance

None of this is easy, of course. In particular, social care cuts are having an impact across the whole system. And healthcare expenditure in the UK has fallen far behind many of its European neighbours. However, by focussing attention on the hospital system to the detriment of primary care, we could make the situation even worse.

You can see an interview with Prof Martin Roland about this story on Cambridge TV here.

Roland, M. & Everington, S. Tackling the crisis in general practice. BMJ 2016; 352:i942 doi:



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