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Happy Anniversary? 5 Years on From the GP Forward View, What Comes Next?

2021 marked the five-year anniversary of the GP Forward View (GPFV), which was published in April 2016. At the time of its inception, it committed an extra £2.4 billion annually to support general practice services by 2020/21. This was aimed at improving patient care and access, and investing in new ways of providing primary care. The plan was developed with the Royal College of General Practitioners (RCGP) and Health Education England (HEE) and contained over 80 specific, practical and funded plans. It also listed ten so-called ‘high-impact actions’, many of which have come to dominate the health and social care agenda in recent years:

  1. Active signposting
  2. New consultation types
  3. Reduce DNAs
  4. Develop the team
  5. Productive workflows
  6. Personal productivity
  7. Partnership working
  8. Social prescribing
  9. Support self-care
  10. Develop QI expertise

But recently, comparatively little has been heard of the GPFV, with the new GP contract and PCNs dominating instead. Here we take a look at how successful it has been and ask what impact it has had on you and your practices (follow the link to our survey at the end of the article). 

An important landmark

As ever with healthcare in the UK, it is a mixed picture. The GPFV has helped to show that the struggles of GP surgeries are being listened to, crucial in the battle for hearts and minds. It was a commendable and important landmark for general practice, representing a new approach, in the words of the Royal College of GPs.

It also emphasised the importance of access, and made this front and centre. Its focus on new ways of delivering care certainly kick-started the process of innovation and digital uptake, but it was Covid that really pushed through the major shift we’ve recently seen.

But efficiencies have been made thanks to the GPFV; NHS England has reported that its 10 High Impact Actions have saved hundreds of thousands of hours for both GPs and administrative staff - never more important in today’s fractious and over-stretched practices.

Flawed from the start?

Many believed that the plan set out was flawed when it was launched and that it remains flawed to this day, in that it gave money and resources to address the symptoms of problems but not the root cause of them. Those causes are most often chronic, systemic failures in the NHS.

Others say that even if the 5,000 more GPs that were promised had been found, if the job impacts their mental and physical health so badly that they burn themselves out or leave, then you are back to square one. And for many, 5 years is simply too long a time frame to plan for in one document.

Above all, perhaps, the assessment of general practice and its staff by way of statistics and reports is not nuanced enough to really show the worth that they bring to patients and communities. The idea of ‘place’ and local populations continues to be a crucial part of all NHS planning – but to try and solve problems with high-level, top-down initiatives is to miss the point somewhat.

Major overhaul

In their ‘Assessment of Progress’ (published in year 2 of the 5-year plan), the RCGP called for a major overhaul to the document. They warned that its good intentions were at risk due to lack of staff.

Many of the concerns and pleas from the RCGP in 2017 sound strikingly similar to those being issued right now from around the sector. “At this stage, there is damage limitation needed in the immediate short-term, with serious long-term planning for the future to safeguard the profession and patients” said the RCGP, 4 years ago. But last year, the government resisted plans to publish bi-annual, objective workforce projections, leaving the Health and Social Care Committee to note last month that there is “a gap between ministerial rhetoric about supporting frontline staff and refusal in practice to do the biggest single long-term change that would relieve the pressure they face”.

Not only that, but a “long-term workforce strategy will not arrive until Spring 2022, by which point the money from the Spending Review funding will already be arriving in the system”, meaning it will be too late to make any real impact.

The Health Foundation also noted that other good intentions in the GPFV have not come to fruition either: “In 2016 the GP Forward View acknowledged that Carr-Hill [funding allocation formula] is ‘out of date and needs to be revised’, promising a new funding formula for general practice. But 5 years later this has not materialised.” Workarounds have been attempted, but a funding gap remains.

What next?

There is the current GP contract, designed to provide the building blocks for a more stable and sustainable future. In December 2021, the new NHS CEO Amanda Pritchard also published the following priorities for 2022/23:

  1. Invest in our workforce
  2. Respond to COVID-19 ever more effectively
  3. Deliver significantly more elective care
  4. Improve the responsiveness of urgent and emergency care
  5. Improve timely access to primary care
  6. Improve mental health services
  7. Continue to develop our approach to population health management
  8. Exploit the potential of digital technologies
  9. Make the most effective use of our resources
  10. Establish ICBs and collaborative system working

Most, if not all of these, will sound familiar. Many, such as the workforce planning aims, seem to have be restated with regularity for almost as long as the NHS has been making plans. Some are currently being stymied by Covid, in particular where elective care is concerned. The digital push is crucial, but we also have to be careful not to leave the vulnerable behind (see our article from 2021 on this topic). Five years on from its publication, it’s less a happy anniversary and more of a sobering milestone on a very long journey to the NHS’s recovery and improvement.

We'd love to know your thoughts on the impact of the GPFV on you and your practice. Fill out our survey and let us know:

Thornfields offer training courses on many of the topics set out in the GPFV and in other NHS plans, such as Active Signposting, Social Prescribing, Correspondence Management, and Total Teamworking. Contact them on 0333 240 4055 or via their online enquiry form.


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