Sajid Javid has announced plans for big changes in primary care, based on a report from the think tank Policy Exchange.
The 98-page report was written by two academics and a private sector oncologist, advised by a motley array of 38 individuals including a gamut of private sector interests such as askmyGP, eConsult, Livi, Assura, Babylon Health, Modality Partnership, Palantir … and Mark Warman, Tory MP and former Technology Editor of the Daily Telegraph.
Interestingly the report argues GPs “want their voices heard in the design and organisation of integrated care” – but the authors don’t seem bothered to allow any GP views to be heard on primary care. Just four GPs were included in the long list: and it’s not clear how they were chosen or whether any of their comments were included.
If it’s primary care this gang are proposing, then it’s not as we know it.
The report wants the restructured primary care to work in a completely different way, with a new online ‘NHS Gateway’ “evolving” to become “a ‘smart’ triage tool for primary care.”
“This would include using machine learning and AI (Artificial Intelligence) to direct consumers to services (including those delivered beyond the neighbourhood) based upon real-time service activity information and patient data.”
Any notion of recruiting sufficient GPs and staff to run services locally appears to have been abandoned. Instead services would be increasingly structured around apps and remote consultations – so remote that it even discusses “opportunities to enable NHS-trained GPs who have left the country to deliver remote sessions from overseas.” It explains: “Remote consultation represents a possibility for GPs trained in the NHS but have since emigrated to deliver sessions from abroad.”
As expected, the report, which was endorsed by a Foreword from Sajid Javid, seeks to phase out the existing system of general practice, and move over ten years to a model in which GPs become salaried employees, probably working for NHS trusts.
And after years of failure to make the promised investment in primary care, it suggests a £6bn ‘rescue package’ – to “gradually buy-out the GP owned estate” and “fund the transition to scaled models over the remainder of the decade.”
Some socialist GPs have long campaigned for salaried status in place of the traditional arrangement in which ‘partnerships’ work to a contract with the NHS, which was conceded as a compromise by Nye Bevan in 1948 to get reluctant GPs on board as the NHS was launched.
But any steps to replace the current arrangements while GPs are still under such stress has to be discussed and negotiated with GPs themselves, not imposed upon them by politicians and a bunch of self-interested outsiders.
Nuffield Trust chief executive Nigel Edwards said general practice is “the bedrock of the NHS,” and warned Javid his reform will fail if it undermines the work of GPs and prevents them from co-ordinating care for patients.
The BMA warns “taking a sledgehammer to the partnership model will not fix general practice,” and Royal College of General Practitioners chair Professor Martin Marshall said the College ‘agrees’ that a ‘comprehensive rescue package is urgently needed for general practice,’ but said:
“We would advise caution against implementing wholescale changes to the way GP care and services are delivered and how patients access them, without properly piloting and evaluating such initiatives in terms of efficiency, patient safety and how they impact on the long-standing trusted relationships between family doctors and their patients.”
But with so many private companies baying at the heels of Javid and his policy wonks it seems caution is the last thing on their minds. The Policy Exchange document makes a token reference to the many millions of digitally excluded:
“… patients for whom remote consultation is less suitable: the very unwell or those with high-risk conditions; those who have difficulty communicating; have complex health; want or need a physical examination; need supervised check-ups, or do not own, or wish to use a smartphone to access services.”
But these concerns are likely to be brushed easily aside in the dash for easy profits. This issue is likely to run and run – attracting more comment and making more waves than the Health and Care Bill.
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