New organisations that provide GP and hospital services, together with mental health, community and social care have been proposed by NHS England.
NHS England's five-year forward view said that GP practices should be allowed to "join forces" into single organisations that provide a broader range of services, including those traditionally provided in hospital.
And patients should be given more control over their care. NHS England have committed to giving patients the option of combining health and social care, and new support for carers and volunteers.
It concludes that although a better future is in view for the NHS, action will be needed on three fronts - demand, efficiency and funding. More action on any one of the three will reduce the pressures on the other two. It shows how delivering on the transformational changes set out in the Forward View, combined with staged funding increases as the economy allows could feasibly close the £30 billion gap by 2020/21, and secure a far better health service for England.
Dr Maureen Baker, chair of the Royal College of GPs said the report recognises that general practice is one of the greatest strengths of the NHS, but that primary care has been under-resourced compared to hospitals.
She said: “We hope that the publication of this report will prove to be the moment that, as a nation, we stared into the abyss and decided that general practice had to be saved from extinction. We strongly support the need for new models of care, particularly for GP practices to work within federations. However, models under which GPs are made employees of hospitals – and therefore can no longer independently advocate for their patients – should only be considered where there is clear agreement across the local health economy that this is the best solution and that GPs feel this will benefit general practice and patients in that locality.
“We particularly welcome the commitment to introduce incentive schemes to attract more GPs to work in deprived areas and help tackle health inequalities."
Dr Baker urged all three major parties to work with NHS England to set out a roadmap as to how they would implement the recommendations of this powerful report.
Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee added: “It is encouraging that NHS England’s Five Year View recognises the issues facing general practice and politicians must now act urgently to deliver its proposals.
“On new ways of working, the BMA has already been supporting groups of practices who are working together in larger structures. However, there is no one perfect model for this and one size does not fit all. The same applies to hospitals taking over GP practices.
“This may be the only possible option for some practices struggling to remain viable – such as a small number of remote, rural GP practices, but there is little evidence that this is needed or necessary for most of the country and could make matters worse for patients rather than improve services.”
David Behan, the chief executive of the Care Quality Commission said: “Our inspections are continuing to tell us that there is too much variation in the quality and safety of health and social care. This is why we support the Five Year Forward View for the NHS, which sets out how the service needs to evolve, so that the needs of patients can be met and so that we can close the care gap.
“As the regulator of health and social care, our role is to use our inspections and what people tell us, to identify what is working well and why, and what does not work. We want this to drive improvement, with providers learning from the services that we rate as good and outstanding."