General practice forms the cornerstone of the NHS in the UK. It plays a vital role as the frontline of the majority of NHS care, and remains highly valued by patients. However, it is also under huge pressure and needs urgent support, as outlined in the BMA’s Saving general practice report.
This report looks at what the UK can learn from health systems across the world, focusing specifically on the funding, structure and role of general practice in seven countries: Australia, Canada, France, Germany, the Republic of Ireland, the Netherlands, New Zealand and Sweden.
Similar methods exist for raising public funding for healthcare across countries, whether through general taxation or statutory health insurance. However, the level of purchasing private health insurance varies considerably – to note, around 11% of the UK population purchase private health insurance compared to 95% of the population in France. Each model of healthcare funding has its own benefits and challenges. However, a country’s context, history, and social values can often impact its healthcare model’s effectiveness.
There is also no clear model that works best for allocating a proportion of this funding to general practice. Capitated payments, fee-for-service payments and pay-for-performance payments all have their advantages and disadvantages. Charging patients for GP services has been a topic of debate within the NHS. However, it is questioned how effective this would be due to the complexity of introducing these charges and the additional administration costs and new bureaucracy they could bring at a time when many GPs want to see this reduced. The impact these charges have had on patients in other countries - often contributing to health inequalities, also needs to be considered.
Despite the differences in funding models, workload is a common challenge. Many countries cite workload as being unmanageable in general practice and experience the same pressures that impact workload as the UK, such as a shortage of workforce and administrative burdens. Key differences exist in the types of patients that GPs treat in other countries. This raises questions over whether removing or reducing the ‘gatekeeper’ role of GPs in the UK could lead to reduced workload.
After considering the findings of this research the BMA is clear that the NHS is the favoured system of providing healthcare to all in the UK. It is a unique model of healthcare that is proven to work and has a proud record of providing safe, effective and equitable healthcare to patients across the UK. Therefore, it is crucial that government addresses the pressures facing general practice and provides sufficient funding to ensure the sustainability of the NHS.
Read the full report
Saving General Practice
Investment in general practice