GP scenario generation workshop outputs

The CfWI produces quality intelligence to inform better workforce planning that improves people’s lives

General practitioner in-depth reviewScenario generation workshop outputs

Centre for Workforce Intelligence

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Background

The Centre for Workforce Intelligence (CfWI) has been jointly commissioned by Health Education England (HEE) and the Department of Health (DH) to conduct an in depth review of the general practitioner (GP) workforce. The review will consider current workforce supply and the key drivers of future demand for GP services and future supply.

We held a scenario generation workshop with stakeholders on 29 November 2012 to develop four plausible future scenarios to 2030, focusing on high impact, high uncertainty drivers of requirements of the GP workforce.

The scenarios are not intended to be exhaustive nor necessarily ‘likely’, but rather a plausible range of ways the future could unfold.

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Approach

The workshop participants identified a wide range of driving forces that could impact the GP workforce in England up to the year 2030. By looking for causal and chronological relationships, participants clustered the driving forces to produce higher-level factors.

Assessing the clusters for level of impact on the GP workforce and degree of uncertainty, workshop participants agreed on two high-impact and low-predictability clusters to use in the scenarios:

Attractiveness and status of the profession Patient vs. professionally driven workforce development

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The scenarios

Happy GPs, excellent patient

care

Right plan, but wrong tools

GPs good, commissioners

badMeltdown in care

Professionally driven

workforce development

Patient driven workforce

development

Increase in status/attractiveness of

general practice

Decrease in status/attractiveness of

general practice

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Happy GPs, excellent patient care


care



badMeltdown in care




development


general practice


general practice

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Widespread public consultation launched to agree case for change in primary care. Consensus emerged.

Recognition that care is best delivered by a content and motivated workforce led to greater remuneration and flexibility of status.

Increased investment in education and training helped make general practice more attractive, recruitment increased. Retirement bulge avoided and retention increased.

Introduction of increased number of roles for the programme GP with a Special Interest (GPwSI) helped improve interface between primary and secondary care.

NOW 2020 2030

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Increased media and public concern over size of budget. New arrangement held firm due to continued strong public involvement in decision making.

Services (such as MRI scans) increasingly delivered in the community.

A better interface between primary and secondary care due to more varied training.

Increase in multi-professional working helped deliver cost savings.

NOW 2020 2030

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GPs good, commissioners bad


care



badMeltdown in care




development


general practice


general practice

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After the largely successful implementation of CCGs and LETBs, a new GP contract was put in place in 2015. This allowed changes in remuneration and more flexible working opportunities.

Evidence began to surface that the healthcare needs of the population were not being met, possibly due to working in a financially constrained system and poor commissioning decisions.

The press picked up on this story and public support for GP commissioning dropped.

Politicians blamed GPs for making poor commissioning decisions and reflected a public backlash.

NOW 2020 2030

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A change in government meant that the power to commission was removed from GPs, and commissioning bodies (similar to the former primary care trusts (PCTs) were reinstated.

New leadership emerged from the GP workforce, who wanted to focus much more on the delivery of care.

The refocusing of GP attention to clinical issues and of delivering care meant that clinical services were improved, as was the public perception of GPs. They became seen as important navigators of care pathways for patients.

NOW 2020 2030

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care



badMeltdown in care




development


general practice


general practice

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The implementation of LETBs led to increased spending on continued professional development (CPD) and training and education successfully becoming aligned to patient needs.

Contractual issues emerged that reduced GP flexibility, with regionally determined pay and working conditions.

The profession was less attractive, and the status was lowered. GPs became disillusioned with healthcare services and

widening health inequalities, and problems with delivery were observed.

NOW 2020 2030

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In the 2020 election, the opposition party pushed for radical reform of primary care. An increase in privatised healthcare services was observed.

New policies subsequent to this reform led to a plurality of healthcare provision, and consequently a fragmented training system.

The number of different providers led to increasingly complex issues of GP supply, and of the planning of education and training. This lowered the morale of GPs, meaning lower recruitment and a significant gap in primary care.

Demand for GP services continued to increase, while the supply decreased.

NOW 2020 2030

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Meltdown in care


care



badMeltdown in care



Patient workfdriven

orce development


general practice


general practice

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Meltdown in care

The new LETBs suffered from a lack of cooperation and did not plan or invest funds in training strategically. Repeated attempts to address this saw a piecemeal approach to skills development and training strategies.

The federated model initially proved attractive to CCGs, but CCGs buckled under the weight of imposed contractual changes.

The patient voice became more assertive through the use of Quality Outcome Framework targets. Competencies had been defined by interest groups, and were poorly designed.

NOW 2020 2030

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Meltdown in care Due to poorly designed competencies and training, doctors in

training were mismatched to system demand. A scramble for jobs ensued, with increasing numbers failing to find work in general practice. Numbers in medical schools dropped.

Pay and morale fell in medicine as perceived status dropped. Pressure on medical education training budgets meant lower-quality training and higher fees. A decline in leadership compounded the decline in status.

A fractured, siloed approach to training, and continuing contractual issues meant there was a perceived decrease in flexibility. The quality of recruits decreased, and regional recruitment inequalities increased. Provision of care was in meltdown, general practice became an unattractive career, and patients were disillusioned.

NOW 2020 2030

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The scenarios


care



badMeltdown in care




development


general practice


general practice

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Additional scenarios

Early feedback from stakeholders suggested it may be useful to give further consideration to the increasing role of technology in healthcare, and the impact of this on the GP workforce.

To this end we have included two additional scenarios here, which were developed at a similar scenario generation workshop focusing on healthcare sciences. We have adapted these scenarios slightly to ensure their relevance to general practice.

Technology through regulation – high regulation of technological developments, reliable products with public buy-in.

Rise of the machines - low regulation of technology developments, unreliable products.

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Technology through regulation

Technology through

regulation

Rise of the machines

Reliable products with public buy-in

Unreliable products without

public buy-in

High regulation of technological developments

Low regulation of technological developments

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Continued financial constraints meant legislators and civil servants looked towards technology to provide cost savings.

A consensus was reached among stakeholders, whereby technology would be introduced, underpinned by a robust regulatory structure. A non-departmental public body was set up to provide licenses to products, after rigorous testing.

Health technology modules were introduced to training for healthcare professionals, and GPs helped design high-quality products.

A stable health system was maintained, and products helped people self-diagnose and self-manage their conditions.

NOW 2020 2030

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By 2025, public and media frustration grew at a system perceived to stifle innovation.

After initial caution, the products were trusted, and empowered patients demanded more.

The regulatory agency responded to these issues by increasing public participation in decision making.

A large primary care workforce was still needed, with face-to-face consultations remaining at a premium.

NOW 2020 2030

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public buy-in



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Public awareness of technology in healthcare increased, and legislators responded to this by offering commissioners incentives to invest in technology to allow patient self-monitoring.

The role of 'healthcare technician' was heavily expanded, with only basic certification needed. This meant that many GPs and practice nurses found themselves out of work.

Investment in the GP workforce decreased, as patients were able to diagnose and manage their conditions themselves.

Fierce lobbying from the technology industry meant that a 'light-touch' regulatory model was adopted.

NOW 2020 2030

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Rise of the machines Development steady until around 2022, with public buy-in of

the products. A series of mergers led to three major companies providing

telehealth applications to GPs. The market became less competitive.

A loss of competitive edge meant less money was spent on research and development. Applications became unreliable, and misdiagnosis common.

Public trust in technology broke down, and the public reverted to valuing face-to-face consultations.

The cuts made a decade earlier meant that primary care services were ill-equipped to handle these remodelled public attitudes.

Primary care services found themselves tied in to costly long-term contracts with technology companies, and could not service their patients. NOW 2020 2030

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Technology scenarios

Technology through

regulation




public buy-in



www.horizonscanning.org.uk

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Health & Medicine

GP scenario generation workshop outputs