Written evidence submitted by Professor Joanne Reeve (FGP0218)


Executive Summary


  1. My evidence is based on 20 years’ expertise in primary care redesign for whole person healthcare. I am a practising inner city GP (salaried) and professor of primary care at Hull York Medical School. I am internationally known for my expertise on the distinct knowledge work of medical generalism.


  1. Key points in my evidence:



General Practice needs to change


  1. General Practice  is broken:




  1. National and international voices recognise an urgent need for a shift towards whole-person, generalist healthcare systems. 90% of the work of the NHS is done in primary care, and the majority of those consultations (presented patient problems) require a whole-person, tailored (expert generalist) approach. 40% of GP consultations are for ‘medically unexplained symptoms; 10% of medicines are overprescribed and 40% of people taking 5+ medicines a day are burdened by their medication; treatment burden will outstrip multimorbidity as the biggest challenge facing patients and practitioners.


  1. Strong voices will tell you that the General Practice model is fine, and able to deliver generalist care. The problem, they will argue, is simply chronic underinvestment. They will describe the importance of relationship-based care, including continuity, in delivering whole-person care. They will highlight the ‘flexibility’ and innovation of general practice to deal with escalating demand (e.g. role substitution, introducing new team members) and digital technological solutions to supporting coordinated delivery of multi-faceted care (e.g. digital triage solutions).


  1. But these ‘solutions’ fail to tackle the changes needed to support a shift from the transactional, jack of all trades model to a modern practice based on the principles of expert generalist medicine [see #2]. My research has described 4 barriers to delivery of expert generalist medicine in the current general practice setting, summarised as the 4Ps.


  1. Twenty years of work to describe practice-based-evidence demonstrates why we can’t afford not to change (e.g. Kovandzic, Bryce, Andah) , but importantly also how we could (e.g. TAILOR, CATALYST, WISE GP). My submission will describe how a shift to an expert generalist model of general practice can address the challenges you seek answers for; offer evidence of how we are already doing elements of that; and so invite a conversation on how we can scale further.

Addressing your key challenges


  1. Your call for evidence highlights key challenges you seek to address. I start by considering how 3 of these (access, workforce, and practice/contractual design) constitute further evidence of a need to shift to an expert generalist model.             









Describing generalist alternatives










Where next: transitional arrangements


  1. The 1948 model, even with modifications, is outdated. Plans to develop Integrated Care Systems won’t address the challenges recognised in this submission. We need a new model for general practice, and therefore a plan for a transitional stage. Transition allows us to start the work with the early adopters – giving  us opportunities to embed evaluation and learning organisation models within the new general practice set up – so we can refine the end model by a ‘trial and learn’ approach and embed a learning organisation approach in to the new models that emerge. I have started conversations with a local NHS Trust.
  2. I welcome a conversation with the Health Select Committee on how my work can inform the plans under consideration.


December 2021