Primary care 'in foothills' of modernisation, says NHS England director

Mike Bewick, a former GP, said also that primary care must be “shored up” against workforce shortages in the short term and the service was “singularly failing” to attract enough recruits into general practice.

In a wide ranging interview with HSJ, Dr Bewick also set out how primary care could lead a shift to new care models.

He said that despite national calls for general practices to join forces and share resources over the past 18 months, the sector remained “in the foothills of [achieving] that – I don’t think we’re anywhere near the Alps”.

He added: “It’s very easy to use the word ‘networking’ because people sit down and design ideas [but] are they working together and sharing their resources yet? I think that’s limited.”

Dr Bewick said there were a small number of examples, such as the Birmingham Vitality Partnership and Suffolk GP Federation, which had begun “sharing information, best practice, and ultimately starting to share resources”.

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He predicted the fall in the total number of individual practices in recent years, which he put down to amalgamations, would speed up.

In the past decade these numbers have fallen by an average of 90 a year to around 7,960.

He said many small federations of practices could lead to merger.

“What the trend will show is… three or four practices might get together as one, not necessarily 20. So you will probably see a step-change… I think you’ll see a steeper fall.”

“As we start to demand more out of hospital care, people will realise you can only deliver certain aspects of that when you come together.”

Dr Bewick said the biggest steps in care models – such as to the multispecialty community providers or primary and acute care systems proposed in the NHS Five Year Forward View – were likely to be established in areas which struggled the most to recruit staff and had worst health outcomes.

In some other places “traditional GP services are working very well”, he said.

He said NHS England was working with professional groups on short term and longer term solutions to the current shortage of GPs and other primary care workforce.

In the short term this includes making it easier for former GPs or those who have been working abroad to return.

Dr Bewick said at present the NHS was “singularly failing” on the government’s aim of half of trainee doctors to become GPs.

He said the image and profile of GPs as leaders, and their community role, needed to be promoted. “We’ve got to make sure it gets as sexier image as your cardiac surgeon or neurosurgeon,” he said.

However, he called for the NHS to “radically look at the training programme for core [medical] training” so some trainees can decide at a later stage to become GPs or go into other specialties. This could also involve training more “specialist generalists”, who can work in or out of hospital, for example in acute, mental health or children’s care.