Bringing GP services into the fold would finally complete the NHS

The writer is a former health minister, Paul Hamlyn Chair of Surgery at Imperial College London and co-chairs the IPPR’s Commission on Health and Prosperity 

For as long as I have worked in Britain’s NHS, politicians and commentators have declared it to be in a state of crisis, and the calls for reform grow daily.

The challenges of the moment are certainly significant. At the height of the pandemic, routine care was postponed to prioritise Covid patients who needed to be hospitalised. This created an enormous backlog, while demand for services has risen inexorably. Unmet health needs also mean economic harm, as the rise in economic activity due to sickness attest.

It’s a dire situation. But the system would need reform even without the pandemic — not because the NHS is flawed but because its aspiration is to deliver high-quality care for all. And since healthcare exists at the limits of science, high-quality care will always be a moving target. To stand still is to fall back.

In the seventh decade of the NHS’s existence, no patient would expect to be offered the standards of care from 1948, the year it was founded. And we all intuitively understand that medicine progresses. Just look at how mRNA technologies have revolutionised vaccines. Yet some aspects of the health service appear to have been frozen in time.

Chief among them is keeping general practice at arm’s length. Most GPs are private contractors and not NHS employees — an arrangement central to launching the NHS in the postwar period. But that model of general practice cannot keep up with today’s demands.

Modern medicine means people are living with multiple health conditions and for longer, multiplying the complexity of care. Small GP practices — often operating out of converted residential buildings — are unable to meet patient needs. Whether it’s the best digital technology, diagnostics, treatment in the community or just longer opening hours, our primary care system is struggling to provide it.

As a former health minister, my big regret was our failure to persuade GPs to change the way they work, to improve access for patients while raising the quality of care — particularly for people with long-term health conditions such as diabetes or asthma. This demands modern “hub” facilities complete with routine diagnostic capabilities such as X-ray or even MRI, but based in the community.

The previous Labour government concentrated on reforms to hospitals. The coalition and Conservative governments then focused on changing how the purchasing of care is organised. There has been relatively limited attention paid to care outside hospitals. “More care closer to home” has been the ministerial rhetoric, but not the reality. As I proposed in a 2018 review for the Institute for Public Policy Research, now part of Labour’s health proposals, we need a “neighbourhood NHS”.

Without the best new interventions at their fingertips, GPs are having to run ever harder to keep up with demand. Burnout, chronic stress and mental illness are far too common as a result. Young medics have taken note that life as a GP partner offers the painstaking admin of running a business while simultaneously managing heavy clinical workloads. It is hardly surprising that their number is down 20 per cent since 2015 — the number of salaried GPs has risen by 50 per cent in the same period.

Keeping GPs separate from the rest of the NHS is an impediment to reorganising care to meet today’s needs. Offering GPs a right to NHS employment would be a big step forward, as the IPPR recently proposed — and the Labour party has recently backed.

Good GPs can have a positive impact on population health in a way that I and my fellow specialists can only dream of. We must welcome our colleagues from general practice on the same terms as those working in hospitals, and finally complete a joined-up, unified NHS.