NHS England 10 Year Plan

To secure a resilient future for general practice, the 10-Year Health Plan must address the sustainability of the GP workforce, fair and sufficient funding, and operational autonomy within general practice. Funding must follow the patient to enable whichever provider is delivering the work to be appropriately commissioned to deliver the workload.

Funding: Sufficient funding and workforce within all sectors of the NHS is also required to ensure service provision to meet patient needs is available.

Our GPs and practices would like to see a commitment to transforming the NHS over the next decade into a digitally led, home-first, community-second, admission-last model, which prioritises ill-health prevention and builds back holistic care via expert GP-led community practice services.

To enable this, General Practice want to work with the Government to fix the core GP practice contract, to provide the transparency to invest, permit practices, partnerships and GPs to have the resources to transform, rebuild and reinvigorate general practice, and restore general practice as the bedrock of universal care offered by the NHS. The erosion of GP practice core funding for essential patient services needs to be urgently remedied by an increase of least £40 per weighted registered patient – increasing the average daily resource per patient by 11 pence for 2025/26. A minimum investment standard should be determined alongside fair annual funding increases to the GP core contract to appropriately recognise and reflect population growth and inflation. Real-terms re-investment must be channelled into General Practice to retain and return family doctors to safe numbers. General practice must be trusted to determine the workforce required to serve its local population with the removal of bureaucratic financial restrictions and barriers that work against this aim.

Evidence from the NHS Confederation and Carnall Farrar shows how every £1 invested in primary or community care results in up to a £14 return of GDP growth. The independent investigation carried out by Lord Darzi identifies these shortfalls in funding and that patients want a local, familiar family doctor practice.

GP Contract: The GP Contract must also remove contractual barriers that disproportionately affect practices serving deprived and vaccine-hesitant populations, by:

– Allowing personalised care adjustments for childhood vaccinations.

– Resourcing child and adult safeguarding nationally via a directed enhanced service to resource vital work for practices serving our most deprived and vulnerable communities.

– Improving and streamlining faster cancer diagnosis by standardising and enforcing the use of fast-track proformas for urgent suspected cancer pathways across the country, allowing fast-track referrals from any setting, e.g. emergency departments or privately, where patients may present with symptoms suspicious for malignancy.

Digital Improvements: To improve joint working across the system, digital transformation must take place within all sectors. Practice data controller liabilities also need to be covered by adding clinical information governance to the CNSGP (clinical negligence scheme for General Practice) to support improved data sharing.

Representative Organisations: Local Medical Committees should be recognised by all commissioners, as local leaders and representatives of GPs in the contract. Enhance LMC representation on ICB boards and require that ICBs/commissioning bodies engage with all relevant LMCs meaningfully and proactively regarding any matters relating to general practice.

Estates: Lord Darzi recommends developing transformative plans and funding for our ageing estates and infrastructure, which is needed to enhance the currently insufficient estates capacity, but also to increase the available estates needed to support the increasing population.

A commitment is needed to bring care closer to the patient by aspiring to one FTE GP per 1,000 patients by 2040. This should be supported by wrapping community services around the practice footprint – make it personalised and GP-led with the resources, modern premises, and diagnostics to match. Invest in general practice as the expert generalist gatekeeper to ensure equitable outcomes across all communities with resourced wider primary care.

Patient safety and workload: Practices need safe GP to patient list size ratios to ensure manageable workloads and patient safety. The BMA’s Safe Working Guidance, based upon European Union of General Practitioners guidance, recommends that GPs deliver no more than 25 patient consultations per day while also safely managing other practice responsibilities. The NHS must shift patient focus towards a proactive, preventative, holistic, data-driven, expert generalist led community-based footing. Moving away from a reactive and expensive hospital-centred crisis care model will save money for re-investment, as well as lives. Reduce unnecessary bureaucracy and administrative burden in general practice that divert time, effort, and spending from health improvement, needs to become in-bedded within all processes. This can be supported through investment in technologies to support greater automation of administrative processes.

Address inappropriate workload transfer to general practice from hospitals. Lord Darzi identified that more tasks are being moved from secondary care back to primary care, with a flow of letters demanding follow-ups and further investigations causing frustration in GPs and taking them away from direct patient care.

In September 2022, the House of Commons Health and Social Care Committee published a report on the future of General Practice, which set out the values of GP-led care, focusing on prioritising both continuity and the gatekeeping role of the GP as the expert generalist as being key to controlling activity and demand on the wider NHS. The Government should enact the recommendations within the report.

1. Retention of the GP Workforce

The retention of GPs is critical to ensuring effective, accessible, and continuous patient care. To address the workforce crisis, we recommend the introduction of a fully funded, national general practice retention programme. This programme would incentivise GPs and trainees to remain in the profession, targeting a reduction in the GP-to-patient ratio from 1:2300 to a more manageable medium- to long-term target of 1:1000. By prioritising retention, this should support reduced burnout, stabilise practice teams, and create a sustainable model of patient care.

Lord Darzi acknowledges that we have almost 16 % fewer fully qualified GPs than other high-income countries relative to our population. The overall trend is for more GP appointments than ever before, with GPs working harder and seeing more patients. GP morale is low and GPs continue to be driven out of the profession. Retention schemes have never been needed more than they are now and funding for these must be immediately reinstated. A smaller number of patients per GP is associated with higher patient satisfaction. More GPs are needed in under-doctored areas.

There needs to be an expansion to the GP and GP nurse workforce by incentivising work in under doctored areas by reinstating the Targeted Enhanced Recruitment Scheme. Relocation expenses and ‘Golden Hellos’ could alleviate financial barriers to working in remote/rural under doctored areas. We must reinstate the New to GP Partnership Programme. A two-year funded GP fellowship post-CCT practice-level scheme, part-funded from a review of ARRS budgets and productivity, could enable a rapid means to recruit and retain additional GP roles. An ARRS review could free up monies to ringfence funding for practice-based GP nursing fellowships to help practices employ more of the roles they need, and that patients want. Training Hubs’ budgets should reallocate ring-fenced monies to help support such roles. We should ensure a fair deal for GP practice nurse colleagues with deserved investment and resourcing to support parity of terms with their trust-employed colleagues in parental and sickness leave and pay via a reimbursement scheme in the SFE.

Additionally, preserving and supporting the GP partnership model is essential for community-centered care. This model enables GPs to provide continuity and preventive services that promote healthier communities, something that often isn’t feasible within larger or transient healthcare structures. To further support GPs, workload limits should be introduced to ensure safe, sustainable patient care and to protect the wellbeing of both patients and GPs.

A long-term GP contract, aligned with the goals of the 10-Year NHS Plan, is needed to establish a clear foundation for community-based services. Such a contract should emphasise continuity of care and preventive health, both of which are essential for improving health outcomes in the community. Moreover, annual funding must be adjusted in line with inflation and population growth to ensure that resources meet evolving needs, thus prioritising value for money and productivity.

2. Fair Funding for General Practice

A fair distribution of NHS resources is essential to achieve equity and efficiency across the health system. We advocate for an incremental increase in the proportion of NHS funding allocated to general practice, with a goal of reaching at least 15% of total NHS spending. This commitment would stabilise general practice services, helping to meet the increasing demands placed on general practitioners. Furthermore, redistributing Primary Care Network (PCN) funds to core contracts and establishing a “Family Doctor Charter” by 2025 will reinforce the foundational role of GPs in patient-centred care and improve continuity for patients.

Expanding core funding is also crucial to redressing the £660 million deficit accumulated over the past five years. This funding expansion would restore essential resources, enabling general practices to operate more effectively, invest in their infrastructure, and respond to community-specific needs. Without such an increase in funding to general practice services will be required to reduce to protect patient and workforce safety and avoid general practice becoming non-financially viable and surgeries having to close. Current GP standard contracts and funding streams are complex and not fit for purpose, undermining the ability to deliver patient care. This can be addressed through a new invigorated core GMS Contract.

Primary care does more work for a lesser share of the NHS budget. The relative share of NHS expenditure towards primary care fell by a quarter in just over a decade despite rising productivity, an expanding role, and evident capacity constraints.

Hospitals have attracted a greater share of NHS spending, meaning that other settings have disproportionately received a smaller share. There has been a shortfall of capital investment overall compared with other countries. The current system is largely formed around immediate clinical need rather than early intervention or long-term health prospects. This means resource and investment is heavily geared towards hospitals rather than general practice and primary care and the use of block contracts has resulted in a drop in clinical productivity.

Research demonstrates that spending in primary and community settings had a superior return on investment when compared with acute hospital services. This should be the fundamental strategic shift that the NHS aspires to make.

3. Freedom and Autonomy in Practice Management

Autonomy in practice management is essential to enable GPs to respond to the unique health needs of their communities effectively. We propose the removal of ringfencing on funds, granting GP partners the flexibility to allocate resources and make hiring decisions based on their knowledge of local patient demographics. This autonomy would support community-specific health initiatives and allow practices to retain their workforce more effectively by aligning roles and resources to local demands.

Increased control over hiring and resource allocation would strengthen workforce retention. Additionally, allowing current ringfenced funds to cover the hiring of nurses and other vital practice staff would help practices meet immediate needs, improve patient access to care, and create a more adaptable, resilient general practice workforce.

The shift from hospital-based to community-based care is a key objective but presents substantial challenges. Funding into general practice; increased resources could support preventive health measures that can help reduce the burden on secondary care. By addressing workforce retention, ensuring fair funding, and granting greater autonomy in practice management as discussed, community-based practices can deliver the continuity and preventive care needed to reduce hospital admissions. Establishing a long-term GP contract would also provide the stability needed to foster community-based care, while immediate redistribution of funding would address current pressures, making this transition more feasible.

Recognising the critical role of continuity of care is essential in the 10-year NHS plan. We advocate for a commitment to strengthening the expert generalist role of GPs, as they take on the increasing complexity and risk associated with shifting care into the community. This approach will ensure that patients benefit from consistent, long-term care that improves health outcomes.

To support this shift, resources must follow the patient, ensuring that general practice receives adequate funding as patient care transitions from hospitals to community settings. This alignment of resources will empower GPs to deliver the comprehensive, patient-centred care that is fundamental to a resilient NHS.

Other service providers must also be enabled to deliver full episodes of care to their patients, such as prescribing, monitoring and requesting tests.

As more data is shared between organisations, general practice data controller liabilities must be covered by adding clinical information governance to the CNSGP (clinical negligence scheme for General Practice). This is the most cost-effective way to safeguard liabilities.

The GP patient record is integral to patients’ trust in their family doctor, and that integrity must be maintained. Patients will not share their information with their GP if they believe other parties or Government departments may access it.

A more tech-enabled healthcare system offers many opportunities to improve patient outcomes and access, but this must be balanced with privacy concerns and inclusivity. There is widespread support to move from a reactive, treatment-focused approach to a proactive, preventive model of care and neighbourhood teams are encouraged to use data insights and risk stratification to identify patients at high risk of developing chronic conditions or complications. By targeting these patients early, it is hoped that primary care can implement personalised interventions that reduce the likelihood of severe health issues and avoidable hospital admissions.

The current system is largely formed around immediate clinical need rather than early intervention or long-term health prospects. Apart from some QOF domains, funding aligned to general practice does not focus on prevention and the use of different contracting models could enable a clearer focus on this. Resource and investment is heavily geared towards hospitals rather than general practice /primary care and this needs to change. Currently, a significant amount of demand is thought to be going completely unmet in primary care and this is despite notable efforts to increase the number of GP appointments carried out, to maintain access levels. Diminished access to general practice limits people’s ability to receive essential healthcare services and is associated with worse health outcomes in key areas, including higher rates of hospitalisation, premature death and lower life expectancy. Without significant investment in general practice and a new fit for purpose GP contract, it is hard to see the shift to early intervention and prevention taking place.

Continuity of care is key to spotting illnesses earlier and tackling the causes of ill health. As described in the BMA’s PATIENTS FIRST- “Why general practice is broken and how we can fix it “paper, a parent may present with their infant with a same-day acute respiratory illness. Through the examination, history and discussion with the parent, trust is formed and the beginnings of relationship-based care, where opportunities for health promotion and vaccine discussion may better thrive. This is the essence of family medicine that we have lost in England. The role of the GP as an expert generalist must be valued and strengthened to support the delivery of a community-based model of care.

One significant challenge is ensuring patient data privacy while making information accessible to those delivering care. Patients must also be informed and comfortable with how their data is used, which requires transparency and clear communication.

In an era where most of our information is stored digitally, it is natural for patients to want more access to their health data. The NHS app already offers some of this data and should continue to do so. However, Government must work with GPs and other health professionals to ensure that this data does not becomes a vehicle for patients to self-diagnose.

Additionally, technology must be inclusive and adaptable. Designing appointment systems that are responsive to a variety of patient needs, such as accessibility options for elderly or differently-abled patients, is essential for ensuring equitable access to care. Technology can enhance healthcare only if it considers and serves the diverse needs of the patient population.

Ideas for change:

Patients deserve safety, stability and hope. We support the principles outlined in the PATIENTS FIRST” Why general practice is broken BMA & how we can fix it” report and have focused our response on what is required to address the crisis facing general practice and the partnership model. The BMA paper is a patient-led vision for a sustainable NHS, as much as it is the sustainable model for general practice. It asks specifically for:

1. Safe GP services now: Immediate action now to embed solutions which have

already been accounted for in this financial year, but which will help retain the

experienced GPs we have, take on the GPs we need, and mitigate further NHS

GP Practice closures.

2. Stability for next year (2025/26): with a deal for England’s family doctors that will deliver an additional 11p per patient per day, keep practices open and deliver more GP and GP Practice Nurse appointments to stop the 8am rush. Ahead of 2025/26, we need the Government to work with GPC England to agree a 2025 Family Doctor Charter and a minimum general practice investment standard.

3. Longer term hope: The 10-Year NHS Plan provides the perfect opportunity to deliver a new GP contract for patients in England, which defines and protects neighbourhood services and the delivery of out-of-hospital care. Led by family doctors who can develop an encyclopaedic knowledge of their patients, their families, and their communities, they will be able to provide continuity of care for years to come. A significant increase in NHS resource will need to be invested in general medical services in the new national contract to expand its services, and secure the workforce needed to improve patient outcomes, reduce system workload, and reduce the current excessive costs of avoidable care episodes. This will provide cost savings across the NHS – with patients requiring fewer appointments and referrals, and fewer unplanned urgent or emergency care episodes – offering comfort to the Treasury, and to patients as taxpayers.

We need to commit to transforming the NHS over the next decade into a:

– digitally led

– home-first; community-second; admission-last model, which

– prioritises ill-health prevention and builds back holistic care via

– expert GP-led community practice services.