Working in bigger groups of practices must not sacrifice core values, GP leader warns

Authors: Gareth Iacobucci 

Publication date:  04 May 2017


GPs have a “window of opportunity” to transform the way they work but should not sacrifice the values of traditional general practice to do so, a senior GP leader has urged.

Michelle Drage, chief executive of Londonwide Local Medical Committees, which represents over 7000 GPs in the capital, urged GPs to take control of their own destiny and not be distracted by “all the noise” around new models of integrated care. Speaking to delegates at the Londonwide LMCs annual conference on Thursday 27 April, Drage acknowledged the benefits to GPs of working “at scale” in federations and super-partnerships and said that a growing number of practices were doing so in response to workforce pressure.

Drage said that 46% of practices in London that responded to a recent Londonwide LMC survey had a vacancy and that 45% had at least one GP planning to retire in the next three years. “Last year we declared a state of emergency. That GP state of emergency continues,” she warned. But Drage said she was concerned that vehicles for delivering collaborative working such as NHS England’s new models of care risked diluting the values of traditional general practice.

She said, “New models of care [are being] led by political imperatives rather than evidence, pushed by the stick of contract changes and the carrot of funding streams. The ambition of providing care at scale results in the ‘at-scale’ part taking up all the resources and the ‘providing care’ part coming in second place. We cannot have that. Let’s find a better way.”

Drage said that transformation of GP services should focus on connecting GPs “across boundaries” to community services, the third sector, schools, and other agencies that can influence people’s health, while retaining the valued elements of general practice such as the registered patient list and continuity of care.

“Form must follow function, so let’s stop faffing around creating fake models of care. The things you do daily on the ground—that is what drives improvement and innovation. Plans in the sky just drive more plans,” she said.

“We have a window of opportunity. If we are to transform, let us not do it at the expense of our values.”

Gareth Iacobucci The BMJ

Cite this as BMJ Careers ; doi: