#1careRevolution Ramblings


Yesterday Jeremy Hunt unveiled his new deal for GPs.

I watched this on a live stream prior to starting a late morning clinic. To say I was unimpressed would be an understatement.

In his speech Jeremy Hunt has offered:

  • Metric data on staffing levels within primary care
  • £10 million for practices that are struggling
  • An extra year in secondary care placements ‘linked with general practice’ for GP trainees
  • A marketing campaign to make general practice more attractive
  • 5000 ‘extra’ GPs as part of 10000 extra staff now including physician associates
  • Improving routes for returners – so far allowing 50 GPs back into the speciality
  • Premises investment – finally
  • To ‘ask’ NHS England to explore how to reduce bureaucracy and red tape for GPs.
  • Ongoing commitment for the £8 billion ‘extra’ funds to the NHS (not primary care and not really extra as with efficiency savings amounts to a net cut of £14 billion from NHS budget)

There are several ways to dissect and analyse the above and several points have been made in articles by Resilient GPJohn Cosgrove and Dr_zo.

More astounding to me, were comments made by Jeremy Hunt in the Pulsetoday article that GPs should no longer be gate keepers and ‘clock off’  at 7pm.

What all the above shows is that simply : Jeremy Hunt does not understand general practice and GPs.

Firstly the above does not constitute a new deal, more like exploration of a deal. Disappointing for a speciality in chaos from underfunding, workload pressures and workforce shortages that even £20000 ‘golden hellos’ can not fix.

Secondly his deal does not address the current issues facing primary care.

  • While metric data can be useful – details of staffing levels alone will not be effective.  Coupled with demand and workload data might allow better healthcare planning but this was clearly omitted by Jeremy Hunt.
  • The £10 million fund comes with little detail and given past experiences likely to come with more bureaucracy however one of the few positive lights in this ‘deal’
  • The RCGP has been asking for an extra year in GP training for years. It looks like this might happen….sort of. By not offering this extra year training in primary care Jeremy Hunt has shown his priorities again do not favour developing a sustainable healthcare system for the general public.
  • No amount of marketing will change that GPs are drowning at the moment in demand, bureaucracy and monitoring in an underfunded speciality. Fix this and the job becomes attractive and medical students will want to pursue what I still believe to be the best job in medicine.
  • 5000 GPs? I still ask is this an extra on current levels taking us to a total ~40k GPs in England by the end of the Government period of just simply 5000 over five years which will likely lead to a net decrease? See this article on 5k GPs for the maths.
  • Improving returners to our speciality would be great but 50 GPs is not going to fix the workload crisis.
  • Premises investment is sorely needed but negotiating with NHS England and NHS properties in my own experience is cumbersome, bureaucratic and protracted.  Fix this issue and many would be happier.

And in return GPs are being asked to work with Mr Hunt to deliver routine #7dayaccess. Yet again Jeremy Hunt neglects to mention that patients have 24/7 access to GPs through the OOH system. The fact that this has been under-invested and damaged by the inception of 111 is again something kept out of the media.

In short- a few concessions with further cuts in funding to effect a 60% increase (7 -days 8-8) in work cover.

Yet again, we see a lack of evidence and understanding.  Jeremy Hunt himself has admitted this will not work currently. Jeremy Hunt has even stated he does not want GPs to be gatekeepers of the NHS anymore. Let us be clear – this is one of the key reasons the NHS is the most cost effective healthcare service in the world. The concessions above will not deliver a safe and effective service. These concessions will not improve current difficulties facing primary care and will not stop GPs leaving the speciality.

The RCGP recently published their blueprint for primary care which key points include shifting primary care funding back to 11%of the NHS budget.

I also detailed some of the points I felt that needed changing to enable an effective healthcare system in my further blueprint for primary care.

However quick wins are clear:
  • Shift primary care funding back to original levels of 11% of the NHS budget
  • Stop media bashing GPs. Criticism is fair when errors are made, daily media campaigns are evidently being driven by higher authorities
  • Address the indemnity – the next primary care crisis with many GPs now being priced out of OOH and soon in hours care
  • Streamline the monitoring organisations (maybe even cut a few). GMC, CQC, NHS England….all have significant over lap and nebulous roles. Imagine the money saved if it was clear…

I write this blog at the end of a busy day. Born out of helping my practice and patients on my day off due to a practice next door shutting and workload pressures bursting at the seams.

I left the practice at 9pm after the practice shut at 6.30pm following a last minute visit and a mountain of paperwork.

I don’t see things changing and Jeremy Hunt’s #GPnewDeal is frankly a #GPnoDeal.

Change is needed.

A revolution is needed.


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