The Government’s upcoming 10-year health plan will put general practice at its core – but NHS England has warned that any shift in funding or delivery models will require deep system change, not just new resources.

Speaking at NHS Confed Expo last week, NHS England’s National Director for Primary Care and Community Services, Dr Amanda Doyle, said the plan would be ‘very, very GP-centric’ and ‘very people-centred’, while making clear that general practice will not see a sudden influx of new funding.

‘I think the future is positive, but we are not going to have more money to do more of the same in the same way,’ Dr Doyle told delegates.

‘We will never ever have enough money to meet the demand coming through from our ageing, multimorbid patient population by just doing more of the same.’

Instead, she said the left shift in care – moving activity out of hospitals and into primary and community settings – will rely on new models of working, innovation at scale, and integrated neighbourhood teams.

‘So, we absolutely have to accelerate some of the innovation we’ve seen around the access space to the whole raft of how we deliver care across primary care. And I think we’ve got to innovate at scale.’

‘If we were designing a model from scratch, it wouldn’t look like what it looks like now.’

She added that we will need a ‘significant increase in capacity of our primary and community teams’ to meet population needs.’

She said: ‘To do that, the shift left of funding when it comes is not going to come with a bag of money from us saying ‘here you are, put all of that into primary and community and then funding will have shifted left’.

‘It’s going to come by changing the way we work so that we are shifting demand, activity, resource, staff away from hospitals.’

 

The Role of Community Pharmacy

Pharmacy and other providers will also be expected to play a greater clinical role. Dr Doyle noted that while the plan remains ‘GP-centric’, the wider vision is for a model built around neighbourhood delivery.

‘Community pharmacy is increasingly emerging as a key clinical service provider in primary care, and we need that to grow.’

These comments echoed those previously made by Chief Pharmaceutical Officer David Webb and Pharmacy Minister Stephen Kinnock, who have stated that pharmacy will be ‘critical’ to the success of the 10-year plan.

This expanding role for pharmacy comes as NHSE prepares to unlock reforms around skill mix and automation – including hub-and-spoke dispensing and greater use of pharmacy technicians under PGDs – in an effort to shift pharmacists’ time toward clinical services.

 

‘Hard Graft’ and System Design

For general practice, the challenge will be two-fold: adapting to these changes while maintaining stability and doing so at scale.

‘We can’t just shift from a very acute-centric model to one where — as if by magic — neighbourhoods are perfect and community services are scaled up,’ Dr Doyle said.

‘But we can do it a bite at a time… some of it will be payment mechanisms we do at the centre, but some of it will be hard graft.’

And while partnerships remain protected, there is a clear steer toward larger footprint working:

‘I think size matters. However much we wish it doesn’t, I think it does. While we are absolutely committed to protecting partnerships, we’ve got to think about how we commission on a bigger scale.’

 

Change Without a Cheque

This message has also been echoed across wider primary care sector. Leaders from community pharmacy, dentistry, optics and audiology recently issued a joint statement welcoming the Government’s £29bn NHS spending uplift – but warned that without investment, ‘there is little capacity to deliver’ the reforms proposed.

The joint statement called for the new funding cycle to ‘begin the long-term process to rebuild primary care’, highlighting pressures ‘due to a historic focus on specialist settings, bureaucracy and poor workforce planning’.

‘It is clear there is little capacity to deliver the reforms needed and improve the care people receive closer to home without further investment in primary care,’ the statement said.

‘We look forward to further details and meaningful actions to be announced in the coming days and we urge the government to work closely with us,’ it added.

 

A Wait for Detail

The final version of the 10-Year Plan has not yet been published.

As pharmacists and other healthcare professionals await further details, sector leaders are united in the message that ambition must now be matched with action – and funding – if primary care is to fulfil the role many in government are increasingly asking it to play.