General practice
General practice is personal, family, and community-orientated comprehensive primary care that includes diagnosis, continues over time and is anticipatory as well as responsive.
[2] General practice is an academic and scientific discipline with its own educational content, research, evidence base and clinical activity.
In many countries there are initiatives to move services out of hospitals into the community, in the expectation that this will be cost-effective and be more convenient.
[10] Under the pressure of the Coronavirus epidemic in 2020 general practice shifted very quickly to remote working, something which had been progressing very slowly up to that point.
About half of the 1,011 respondents thought their surgeries were not suitable for present needs, and 78% said they would not be able to handle expected future demands.
[21] In 2004, regulations were changed in Labour government reforms to allow new entrants, including commercial companies, to operate one or more general practices, named Alternative Provider Medical Services.
Research in 2015 found that 4% of general practices were being run under these new arrangements, but they had not made improvements in the quality of service though they often operated in more deprived populations.
[22][23] The GP Forward View, published by NHS England in 2016 promised £2.4 billion (14%) real-terms increase in the budget for general practice.
[24] In July Simon Stevens announced a programme designed to recruit around 2,000 GPs from the EU and possibly New Zealand and Australia.
[27] There are also moves to employ care navigators, sometimes an enhanced role for a receptionist, to direct patients to different services such as pharmacy and physiotherapy if a doctor is not needed.
[29] In March 2022 Sajid Javid supported a report by Policy Exchange which described the existing general practice model as "outdated".
He is said to be "considering radical changes to the 70-year-old structure of the NHS that could see many family doctors directly employed by hospitals instead of running their own surgeries.
[37] Commercial providers are rare in the UK but a private GP service was established at Poole Road Medical Centre in Bournemouth in 2017 where patients can pay to skip waiting lists to see a doctor.
Patients with long term medical conditions or who might need home visits were actively discouraged from joining the service.
Richard Vautrey warned that it risked 'undermining the quality and continuity of care and further fragmenting the service provided to the public'.
[40] 85% of patients rate their overall experience of primary care as good in 2016, but practices run by limited companies operating on APMS contracts (a small minority) performed worse on four out of five key indicators - frequency of consulting a preferred doctor, ability to get a convenient appointment, rating of doctor communication skills, ease of contacting the practice by telephone and overall experience.
[42] The British Medical Association collected undated resignation letters in 2017 from GPs who threatened to leave the NHS and charge consultation fees.
