Fourth Report - The future of general practice

The government partially accepts the recommendation but shifts focus entirely from commissioning a review into short-term operational problems to discussing increases in GP speciality training places and changes to training duration (from 18 to 24 months in general practice).

The government partially accepts but redirects the focus from increasing GP training places and extending training duration to the Additional Roles Reimbursement Scheme (ARRS). It commits to increasing ARRS flexibility by adding new reimbursable roles, increasing caps on Advanced Practitioners, and removing caps on Mental Health Practitioners as part of the March 2023 GP contract changes.

The government accepts the recommendation but deflects by addressing the role of receptionists and care navigation training instead of GP trainee distribution and incentives. It commits to investing in a new National Care Navigation Training programme for up to 6,500 staff rolling out from summer 2023, and introducing a Quality and Outcomes Framework module focused on optimising demand in general practice.

The government partially accepts but deflects by focusing on e-prescribing in hospitals and the interface between general practice and hospitals. It rejects a national mandate for a standardised reporting tool, stating that Integrated Care Boards should decide their own approaches to improving communication and local pathways.

The government partially accepts the recommendation but deflects by focusing on exploring opportunities for automating processes in general practice to free up clinical capacity. It highlights ongoing support for two pilots testing automated coding of bowel screening results and other administrative processes in London.

The government's response outlines changes to pension arrangements, including increasing the annual allowance, abolishing the lifetime allowance, and introducing retirement flexibilities, which is entirely unrelated to the recommendation about funding machine learning research for admin reduction.

The government's response discusses the importance of continuity of care, the named GP policy, the Fuller Stocktake, and the role of multi-disciplinary teams, which bears no relation to the recommendation for a review of primary care IT systems.

The government rejects the recommendation by referring to its response to recommendation 17 (which concerned continuity of care models) and reiterates plans to promote the RCGP’s Continuity of Care toolkit, thereby failing to address the substance of NHS pensions for GP partners.

The government partially accepts but defers action, stating further exploration is needed regarding the impact on NHS England and government before committing to accelerate plans for Limited Liability Partnerships.

The government's response discusses ongoing work and future plans for improving primary care IT systems, digital consultation tools, and cloud-based telephony, which bears no relation to the recommendation regarding Additional Roles Reimbursement Scheme (ARRS) uplift or Agenda for Change terms.

The government partially accepts, stating they will introduce methods to promote continuity of care and consider how best to measure it, but will not commit to a specific measure by 2024, which is unrelated to the committee's recommendation on locum work and staff competition.

The government rejects the recommendation, stating that it does not accept it because the size and skills mix of the workforce are matters for individual general practices to determine, which is unrelated to the recommendation on GP pension tax bills.

The government partially accepts the recommendation but discusses current and ongoing work to explore gain sharing agreements and financial incentives to reward primary care for reducing secondary care expenditure, rather than making continuity of care an explicit national priority.

The government partially accepts but deflects the recommendation, discussing existing funding mechanisms like the Carr-Hill formula, which it states will not be changed until the end of 2023/24, instead of addressing the routine measurement of continuity of care.

The government accepts the recommendation but discusses existing and upcoming organisational support initiatives for Primary Care Networks and practices, including digital tools, care navigation training, and the National General Practice Improvement Programme, rather than committing to a national measure of continuity of care by 2024.

The government partially accepts the recommendation but discusses its commitment to the partnership model and existing investments in general practice funding through various schemes, without addressing the specific request for additional funding for PCN 'continuity leads'.

The government partially accepts but deflects the recommendation, discussing challenges related to GP premises, property ownership, and how primary care infrastructure can be supported through the planning system, including updating relevant guidance.

The government partially accepts but deflects the recommendation, stating it needs further exploration before committing to accelerate plans to allow GP partners to operate as Limited Liability Partnerships (LLPs), citing concerns about legal and financial risks and low take-up in Scotland.