General practice is the ‘jewel in the crown’ of the NHS.

A strong primary care sector – including teams of nurses, pharmacists, mental health specialists and allied professionals – has been shown to deliver better health outcomes, a decrease in utilisation of hospitals and emergency departments as well as slower growth in health care spending.

But, in England, general practice also needs fundamental change. There is significant variation in quality, access in primary care is poor, demographics are changing, and GP workloads are increasing.

There is a growing consensus that a shift towards primary care at scale - what we call the ‘neighbourhood NHS’ - is the solution to these problems. Recent government reform initiatives have made some progress in delivering on this vision, but the evidence suggests there is much further to go.

We need a ‘new deal’ for general practice to overcome these challenges. We argue this should be made up of four main components across England.

  • Create neighbourhood care providers (NCPs) to deliver the ‘neighbourhood NHS’.
  • Offer all GPs the right to NHS employment.
  • Reform new GP roles to create career progression, time to care and realistic workload.
  • A radical transformation of the primary care infrastructure.