Editing General practice (section)

===England===
In 2004, regulations were changed in [[Second Blair ministry|Labour government]] reforms to allow new entrants, including commercial companies, to operate one or more general practices, named Alternative Provider Medical Services. Research in 2015 found that 4% of general practices were being run under these new arrangements, but they had not made improvements in the quality of service though they often operated in more deprived populations.<ref name=jrsm-201505>{{cite journal |title=Performance of new alternative providers of primary care services in England: an observational study |last1=Greaves |first1=Felix |last2=Laverty |first2=Anthony |last3=Pape |first3=Utz |last4=Ratneswaren |first4=Anenta |last5=Majeed |first5=Azeem |last6=Millett |first6=Christopher |journal=Journal of the Royal Society of Medicine |volume=108 |issue=5 |date=May 2015 |pages=171–183 |doi=10.1177/0141076815583303|pmid=25908312 |pmc=4484211 }}</ref><ref name="SO2004/291">{{cite web |url=https://www.legislation.gov.uk/uksi/2004/291/contents/made |title=The National Health Service (General Medical Services Contracts) Regulations 2004 |id=SI 2004/291 |publisher=UK Parliament |year=2004 |access-date=31 July 2023}}</ref>

The GP Forward View, published by [[NHS England]] in 2016 promised £2.4 billion (14%) real-terms increase in the budget for general practice. [[Jeremy Hunt]] pledged to increase the number of doctors working in general practice by 5,000. There are 3,250 trainee places available in 2017.  The GP Career Plus scheme is intended to retain GPs aged over 55 in the profession by providing flexible roles such as providing cover, carrying out specific work such as managing long-term conditions, or doing home visits.<ref>{{cite news|title=Jeremy Hunt: The NHS is turning a corner - and I want GPs at the heart of it|url=http://www.gponline.com/jeremy-hunt-nhs-turning-corner-i-want-gps-heart/article/1437052|access-date=16 July 2017|publisher=GP Online|date=20 June 2017}}</ref>  In July [[Simon Stevens (NHS England)|Simon Stevens]] announced a programme designed to recruit around 2,000 GPs from the EU and possibly New Zealand and Australia.<ref>{{cite news|title=NHS to recruit 2,000 GPs from abroad|url=https://www.hsj.co.uk/primary-care/exclusive-nhs-to-recruit-2000-gps-from-abroad/7020094.article?|access-date=17 July 2017|publisher=Health Service Journal|date=17 July 2017}}</ref>  According to [[NHS Improvement]] a 1% deterioration in access to general practice can produce a 10% deterioration in emergency department figures.<ref>{{cite news|title=10 ways a vanguard improved care|url=http://healthcareleadernews.com/article/10-ways-vanguard-improved-care|access-date=23 August 2017|publisher=Healthcare Leader|date=1 July 2017|archive-url=https://web.archive.org/web/20170823203249/http://healthcareleadernews.com/article/10-ways-vanguard-improved-care|archive-date=2017-08-23|url-status=dead}}</ref>

GPs are increasingly employing [[pharmacist]]s to manage the increasingly complex medication regimes of an aging population. In 2017 more than 1,061 practices were employing pharmacists, following the rollout of [[NHS England]]'s Clinical Pharmacists in General Practice programme.<ref>{{cite news|title=Revealed: Next 67 areas recruiting 'clinical pharmacists'|url=https://www.chemistanddruggist.co.uk/news/next-67-areas-recruiting-clinical-pharmacists|access-date=19 July 2017|publisher=Chemist & Druggist|date=18 July 2017}}</ref>  There are also moves to employ care navigators, sometimes an enhanced role for a receptionist, to direct patients to different services such as pharmacy and physiotherapy if a doctor is not needed. In September 2017 270 trained care navigators covering 64,000 patients had been employed across [[Wakefield]]. It was estimated that they had saved 930 GP hours over a 10-month trial.<ref>{{cite news|title=Primary care 'Care navigators' to help free up GP schedules|url=https://www.pharmaceutical-journal.com/20203648.article|access-date=23 December 2017|publisher=Pharmaceutical Journal|date=28 September 2017|archive-date=24 December 2017|archive-url=https://web.archive.org/web/20171224213747/https://www.pharmaceutical-journal.com/20203648.article|url-status=dead}}</ref>

Four [[NHS trust]]s: [[Northumbria Healthcare NHS Foundation Trust]]; [[Yeovil District Hospital NHS Foundation Trust]]; [[Royal Wolverhampton NHS Trust]]; and [[Southern Health NHS Foundation Trust]] have taken over multiple GP practices in the interests of integration.<ref>{{cite news|title=How is primary and secondary care integration impacting trusts?|url=http://healthcareleadernews.com/article/how-primary-and-secondary-care-integration-impacting-trusts|access-date=16 July 2017|publisher=Healthcare Leader|date=22 June 2017|archive-url=https://web.archive.org/web/20180124150959/http://healthcareleadernews.com/article/how-primary-and-secondary-care-integration-impacting-trusts|archive-date=2018-01-24|url-status=dead}}</ref>  In March 2022 [[Sajid Javid]] supported a report by [[Policy Exchange]] which described the existing general practice model as "outdated".  He is said to be "considering radical changes to the 70-year-old structure of the NHS that could see many family doctors directly employed by hospitals instead of running their own surgeries."<ref>{{cite news |title=Javid backs report calling for GPs to be 'directly employed' by the NHS |url=https://www.hsj.co.uk/primary-care/javid-backs-report-calling-for-gps-to-be-directly-employed-by-the-nhs/7032012.article |access-date=22 April 2022 |publisher=Health Service Journal |date=4 March 2022}}</ref>

[[GP Federation]]s have become popular among English [[General practitioner]]s.<ref>{{cite news|title='GP federations' are the future of the NHS|url=https://www.telegraph.co.uk/news/health/7419510/GP-federations-are-the-future-of-the-NHS.html|access-date=23 May 2017|publisher=Telegraph|date=11 March 2010}}</ref>

====Consultations====
According to the [[Local Government Association]] 57 million GP consultations in England in 2015 were for minor conditions and illnesses, 5.2 million of them for blocked noses.<ref>{{cite news|title=Millions of 'unnecessary' GP visits are for coughs and colds, says LGA|url=http://www.thecommissioningreview.com/article/millions-unnecessary-gp-visits-are-coughs-and-colds-says-lga|access-date=15 December 2016|publisher=Commissioning Review|date=7 November 2016|archive-url=https://web.archive.org/web/20161220163916/http://www.thecommissioningreview.com/article/millions-unnecessary-gp-visits-are-coughs-and-colds-says-lga|archive-date=2016-12-20|url-status=dead}}</ref>   According to the [[King's Fund]] between 2014 and 2017 the number of telephone and face-to-face contacts between patients and GPs rose by 7.5% although GP numbers have stagnated.<ref>{{cite news|title=GP contacts with patients up 7.5% in two years|url=http://www.gponline.com/gp-contacts-patients-75-two-years/article/1435259|access-date=6 July 2017|publisher=GP Online|date=1 June 2017}}</ref> The mean consultation length in the UK has increased steadily over time from around 5 minutes in the 1950s to around 9·22 minutes in 2013–2014.<ref name="Irving et al 2017">{{cite journal |doi=10.1136/bmjopen-2017-017902 |pmid=29118053 |pmc=5695512 |title=International variations in primary care physician consultation time: A systematic review of 67 countries |journal=BMJ Open |volume=7 |issue=10 |pages=e017902 |year=2017 |last1=Irving |first1=Greg |last2=Neves |first2=Ana Luisa |last3=Dambha-Miller |first3=Hajira |last4=Oishi |first4=Ai |last5=Tagashira |first5=Hiroko |last6=Verho |first6=Anistasiya |last7=Holden |first7=John }}</ref><ref>{{cite journal |doi=10.1016/S0140-6736(16)00620-6 |pmid=27059888 |pmc=4899422 |title=Clinical workload in UK primary care: A retrospective analysis of 100 million consultations in England, 2007–14 |journal=The Lancet |volume=387 |issue=10035 |pages=2323–2330 |year=2016 |last1=Hobbs |first1=F D Richard |last2=Bankhead |first2=Clare |last3=Mukhtar |first3=Toqir |last4=Stevens |first4=Sarah |last5=Perera-Salazar |first5=Rafael |last6=Holt |first6=Tim |last7=Salisbury |first7=Chris }}</ref> This is shorter than the mean consultation length in a number of other developed countries around the world.<ref name="Irving et al 2017"/>

The proportion of patients in England waiting longer than seven days to see a GP rose from 12.8% in 2012 to 20% in 2017.<ref>{{cite news|title=More patients waiting longer than a week for GP appointments|url=https://www.theguardian.com/society/2017/jul/06/more-patients-waiting-longer-than-a-week-for-gp-appointments|access-date=7 July 2017|publisher=Guardian|date=6 July 2017}}</ref> There were 307 million GP appointments, about a million each working day, with more on Mondays, in the year from November 2017. 40% got a same-day appointment. 2.8 million patients, 10.3%, in October 2018, compared to 9.4% in November 2017, did not see the doctor until at least 21 days after they had booked their appointment, and 1.4 million waited for more than 28 days. More than a million people each month failed to turn up for their appointment.<ref>{{cite news |title=One in 10 patients waiting three weeks to see GP, figures reveal |url=https://www.itv.com/news/2018-12-07/one-in-10-patients-waiting-three-weeks-to-see-gp-figures-reveal/ |access-date=10 December 2018 |publisher=ITV |date=7 December 2018}}</ref>

Commercial providers are rare in the UK but a private GP service was established at Poole Road Medical Centre in Bournemouth in 2017 where patients can pay to skip waiting lists to see a doctor.<ref>{{cite news|title=NHS GP practice sets up a private service - by paying up to £145 to jump the queue|url=http://www.dailyecho.co.uk/news/health/15071421.NHS_GP_practice_sets_up_a_private_service___by_paying_up_to___145_to_jump_the_queue/|access-date=14 July 2017|publisher=Southern Daily Echo|date=6 February 2017}}</ref>

GP at Hand, an online service using [[Babylon Health]]'s app, was launched in November 2017 by the Lillie Road Health Centre, a conventional GP practice in west London.  It recruited 7000 new patients in its first month, of which 89.6% were between 20 and 45 years old. The service was widely criticised by GPs for cherry picking. Patients with long term medical conditions or who might need home visits were actively discouraged from joining the service. [[Richard Vautrey]] warned that it risked 'undermining the quality and continuity of care and further fragmenting the service provided to the public'.<ref>{{cite news|title=Cherry picking fears confirmed as 7,000 new patients join GP at Hand|url=https://www.gponline.com/cherry-picking-fears-confirmed-7000-new-patients-join-gp-hand/article/1453102|access-date=25 December 2017|publisher=GP Online|date=18 December 2017}}</ref>

The [[COVID-19 pandemic in the United Kingdom]] led to a sudden move to remote working.  In March 2020 the proportion of telephone appointments increased by over 600%.<ref>{{cite news |title=Official data demonstrates rapid rise of remote GP consultations |url=https://www.hsj.co.uk/coronavirus/official-data-demonstrates-rapid-rise-of-remote-gp-consultations/7027540.article |access-date=8 June 2020 |publisher=Health Service Journal |date=30 April 2020}}</ref>