Written evidence submitted by Andrew Elphick, CEO and Toby Quartley, Joint Chair & Medical Director (FGP0362)


Rt Hon Jeremy Hunt

Health and Social Care Committee Chair


Re: Inquiry on The Future of General Practice



Context – Principal Medical Limited are one of the largest GP owned GP Federation organisations in the country. We are a “not for profit”, GP owned provider organisation, directly involved in the delivery of both the provision of General Practice (via both corporately controlled salaried GMS practice and corporately controlled partnership GMS practice structures). We also provide a range of commissioned community physical and mental health services across (from both CCG and County Council) Oxon and Northants.


What are the main barriers to accessing general practice and how can these be tackled?





morphed into feelings of active “scapegoating” of GPs by government for the broader ills of the system.







*This is already having an interesting side effect. In a tight market a flexible workforce can use these portals to better understand how in demand their skills are and what (increasing) value the system will place upon them. This increased dynamic transparency allows those willing to “play the market” to stand aside until the prospect of an unfilled shift drives up the price.






i)  the generic impacts of patients being unable to access General Practice in a timely fashion, both on the critical and timely provision of their care, supporting better acute and chronic

health outcomes but also the possible impact it could have to displace “GP demand” into other services and

ii)  the specific preferences of a patient to use their preferred method.

With due regard to the needs of specific groups (physically and learning disabled, digitally or language disadvantaged) access to GP services needs to be offered via a number of platforms. The reality is that access preference, in this context, needs to be driven by the provision of options, safety and broad-based utility and not necessarily patient convenience.






team from general practice and beyond, which covers the patients of the PCNs and potentially a broader area rather than just those of an individual practice.







Clearly some areas of the country have greater/lesser exposure to skills shortages. In some areas particularly around London, local skills shortages are exacerbated by a high cost of living, and the absence of a London weighting. In these areas, some staff are willing to commute in to London to benefit from premium pay rates, while the cost of living makes it difficult to draw staff in from other lower cost areas. In areas like Oxfordshire, we are very close to experiencing a substantive failure in provision due to these factors.



General Practice should be the cornerstone of the prevention agenda. GP-based teams have by far the largest interface with their patients and unlike all other parts of the NHS GPs serve almost the complete population and not just those with a specific/transient need.


Despite the promise of more integrated working between council-commissioned services and health-commissioned service driven through a national NHS structure, we feel that a better alignment between prevention investments and better health outcomes and savings could be achieved if the prevention strategies and funding where formally aligned to the health services.




I.            Shortages of planned care capacity and the resulting waiting lists and patients backlog and

II.            The apparent desire of Acute providers to pass off work traditionally undertaken by them in an outpatient setting or the care and/or monitoring tasks between or after episodes of hospital care has been very significant.








that the System continues to recognise that General Practice is a “broad church” and to work to simplify and standardise the operation of GMS contracting so that all models of contract “ownership” can thrive. The smooth transition from one model of contracting ownership model to another is not something which is easily undertaken and involves potentially exposing the prize asset of the practice - its GMS contract - to the vagaries of commissioning interpretation. Certainty as to how contracts can be passed, without potential exposure to the market, from a partnership and into a qualifying corporate structure for example, would support smooth transformation and give those organisations in the system clarity and reassurance for sustainable transformation.


engage with the “higher missions” prescribed by the system.



o To some extent covered by the answer given above. Most PCNs are still a long, long way from being the effective focus of proactive,

personalised, coordinated and integrated care. They are actually too small to create an at-scale nexus for care at a logical scale “above” most individual practices, and in many areas they have been formed and configured with scant regard to any operational, geographical or population health based principles. To make sense going forward, they will need to work together at scale and to serve a common population that has some logical coherence beyond GPs. Once we make that step change then we may question the need for PCNs operating at a scale between practice (which are getting larger on average) and areas /network of networks/Sub-Place.



In reality we have yet to see a significant freeing-up of GP time. Every day demand on General Practice outstrips capacity. The excellent partnerships we have do not provide increased GP capacity, but may reduce demand on secondary care services more in some cases. General Practice requires increased financial resource, trained staff, reduced administrative burdens, more clout in local ICSs to stand up to acute and community trusts in defining future care provision, and a government who supports their struggles, rather than one who weaponises the service and produces unrealistic patient expectations of what can be achieved with the limited resources available.





Andrew Elphick              Toby Quartley

CEO              Joint Chair & Medical Director


Dec 2021