Reorganisation of general practice: be careful what you wish for.

Abstract

With the recent publication of the NHS Long Term Plan 1 and the renewal of the GP Contract,2 it is timely to consider what we value within general practice. In this article we consider normative ways of thinking about general practice and the implications for primary healthcare organisation and funding. We examine some of the opportunities and challenges that current ‘common sense’ thinking produces, shaping ways in which particular ‘problems’ and ‘solutions’ are constructed and accepted.3 We discuss potential ‘gaps’ or ‘alternative’ ways of thinking and their potential contribution to future policy and practice. Many have referred to NHS general practice as being in crisis.4,5 Debate about this crisis has included discussion of GP retention and recruitment in relation to capacity and service demand. The difficulties experienced in primary care have been exacerbated by factors including rising patient numbers and changes in the nature of work.5 For these reasons, general practice provided under the conventional principles of comprehensive care (that is, a patient can attend with any problem) to a universal set of patients, while maintaining a supportive and continuous relationship,6 is frequently described as unsustainable.4 In the short term, within current models of working, there are not enough GPs to meet the demand to treat patients with increasingly complex problems. The naming of a general practice ‘crisis’ has led to a number of initiatives attempting to address this. Policies have promoted IT, mixing of skills, role expansion, and delegation of tasks to …