The GP Five Year View. 4 strategic issues

The GP Five Year View. 4 strategic issues

I finally read it

It’s def worth a read if you haven’t 
https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

I thought it was ok…..it left me with some hope and many positive points

I won’t dwell on these. 
There were a few strategic issues that I thought were significantly underplayed or absent

1) lack of evidence for some of the ideas expressed

Lots of un evidenced ideas, and ideas where there IS evidence but evidence says ‘doesn’t make much difference’ (and even where it does where’s the evidence on cost effectivness? – reflects our unfortunate penchant for magic bullet syndrome / simply ignoring the evidence etc…

I’m all for innovation, but it carries risk and we should tread carefully and evaluate thoroughly if we are doing innovation. 

Where there’s evidence an idea doesn’t work (& just because it’s in an ‘official’ document don’t think there’s evidence behind it) we should ignore it. Where there’s no evidence of cost effectiveness we should either test this, and or build the evidence as we progress though thorough evaluation.
2).  The document completely ignores inequality. I don’t find this acceptable 

Completely ignores the concept of inequality and certainly in England at least ignores the structural inequality inherent in the current distribution of GP funding within the contract. As Prof Watt from Glasgow points out – flat slope of funding per capita and v steep slope of need across a population – http://bjgp.org/content/65/641/e799. 

See especially figure 1 http://d1ksgr6v5tsksf.cloudfront.net/content/bjgp/65/641/e799/F1.large.jpg
Kabiz Boomla has shown similar in e London – http://www.bmj.com/content/349/bmj.g7648
The GP forward view seems to ignore this. It’s important! Set this way the distribution of GP funding is in itself a determinant of health, it’s unacceptable to avoid this even it it is uncomfortable.
3). Where’s all the cash. Oh it’s in the hospital. Get it out of there.

Completely ignores the main deal – till the cash is shifted from hospital to non hospital setting (not just GP) anything other runs the risk of playing at the at the edges. In a recent presentation in Sheffield prof Watt put up this graph. (Yes I know there are some significant caveats).

4) develop much wider thinking of the model of “primary care”. A missed opportunity?

Underplays the concept of a wider model of primary care that stretches well beyond “health” and the NHS but out to services in the volcom sector and the local & central government funded or provided services

This again is a major deal, and getting this right will enable “health” to really get stuck into the determinants of heals that the rhetoricians say it must….there are many ways to develop operational models for this. We need to sort this, and do so soon.

All up, my take is great work, more to do.

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