The National Association of Primary Care (NAPC) has been reflecting on the emerging direction of general practice policy. This note sets out our high-level perspective, as a membership organisation, drawing on our long-standing work in population health, neighbourhood care, and primary care transformation.
NAPC’s intention is to contribute constructively to the wider conversation about the future of general practice and to share themes that we believe matter to GPs and their teams. Our position is one based on the reality of current working in general practice combined with the innovation from our wide membership.
NAPC’s overall view
The promised review of the contract represents an important moment for general practice. Beyond individual policy changes, it has the potential to signal a more realistic, trusting and collaborative relationship between general practice and the wider system.
There is an opportunity to:
- Simplify expectations
- Clarify intent
- Reduce unnecessary friction
- Better prepare practices for longer-term reform
At the same time, it is important to acknowledge the current operating context. Many practices are working under sustained pressure, managing high demand, workforce challenges and increasing complexity. Any new requirements, even where well-intended, need to be carefully prioritised, paced and supported to avoid adding cumulative burden.
Neighbourhood health and accountability
NAPC strongly supports the direction towards neighbourhood-based models of care and closer alignment with broader NHS reform.
General practice — and GPs in particular — are well placed to provide medical and system leadership within neighbourhoods, supporting continuity, coordination and population outcomes. For this to succeed:
- Accountability must be matched with capacity and capability
- Investment in clinical leadership is essential
- Funding for core general practice and neighbourhood delivery must be clear and transparent
As patient cohorts become more complex, relational and longitudinal care become even more important. Workforce frameworks should therefore enable flexible, skills-based models that reflect local population need rather than rigid role definitions.
Workforce and the Additional Roles Reimbursement Scheme (ARRS)
We support increased flexibility in workforce arrangements and welcome moves that enable practices and PCNs to shape teams around population need.
Looking ahead, workforce planning would benefit from:
- Moving from job-title-based approaches to a population needs → skills → roles framework
- Supporting emerging roles such as digital support, behavioural health, community health and wellbeing, and analytics capacity
- Avoiding approaches that unintentionally lock practices into historical workforce models
Access, continuity and patient experience
Whilst improving access remains a priority, it is important that access is understood in a meaningful way. For all patients and in particular those with complex or long-term needs, the benefit of access is closely linked to:
- Continuity
- Coordination
- Trusted relationships with clinicians and teams
We would encourage continued exploration of:
- Team-based continuity models
- Proactive neighbourhood approaches for higher-need cohorts
- Measures that focus on outcomes and experience, rather than narrow transactional activity
Reducing transactional burden
We recognise the changing nature of clinical practice and the need for data collection and assurance. However small additional tasks, even when described as “minimal”, can accumulate and have a real impact on workload, quality and safety.
These tasks may be of a clinical nature or an administrative one. There is a real opportunity for a step change to free up time and resource to focus on quality and outcomes.
Quality, outcomes and prevention
We support the ongoing evolution of quality frameworks and would welcome a shift away from multiple small transactional targets towards:
- Population-level outcomes
- Person-centred care
- High-quality clinical decision making
A stronger focus on decision quality and patient agency is more likely to:
- Improve patient and clinician experience
- Reduce unnecessary intervention
- Deliver longer-term system benefits
For screening and prevention, engagement with communities, segmentation and shared decision making are as important as data flows and compliance.
Supporting the workforce and transformation
Sustainable change in general practice requires ongoing support. We support the principle of increasing staff activation. Where this might involve staff surveys, they should be centrally funded and low burden. We encourage inclusion of measures that reflect:
- Professional agency
- Team effectiveness
- Relational and neighbourhood working
More broadly, practices will need continued access to transformation support, including:
- Workflow redesign
- Digital enablement
- Organisational development
- Support for change at different starting points
This support should be continuous rather than one-off, recognising the diversity of practice contexts and the pressures facing system partners.
Collaboration across the system
Effective collaboration is essential for neighbourhood care to work well. For collaboration to be meaningful:
- Responsibilities and expectations should be reciprocal
- Time spent building relationships should be recognised and supported
- Transfer of work should be based on agreement, trust and appropriate resourcing
- Collaboration is required between both commissioners & providers
Approaches that rely heavily on transactional processes risk undermining the relational foundations needed for high-quality care.
In summary
NAPC sees real opportunity in the future direction of general practice policy to:
- Support person-centred outcomes
- Strengthen neighbourhood care
- Enable a more mature and trusting relationship across the system
Realising this opportunity will depend on:
- Careful prioritisation
- Realistic pacing
- Investment in leadership, workforce and transformation
- A shared commitment to reciprocity and collaboration
We look forward to continuing to work with general practice teams and partners across primary care to support the development of sustainable, high-quality services for patients and communities.
If you would like to be part of this, contact NAPC.
