GP leaders have reacted in anger to reports the government is planning to “nationalise” their profession.

No plans have been published but, according to a leaked letter written by Health Secretary Sajid Javid, it could be done by stealth. According to the report in The Times, Mr Javid is enthusiastic to encourage NHS organisations to take over general practice. The organisation leading this approach, the Royal Wolverhampton NHS Trust currently runs ten practices. The new integrated care systems, currently the subject of the latest NHS Bill before Parliament, would also have the ability to run general practice directly.

GP leaders saw the leak as another shot in the confrontation between general practice and the government triggered by controversy over the move to remote consultations. Practices are thought to have voted to give the British Medical Association authority to order industrial action – especially in response to a recent “rescue plan” for general practice which proposed league tables and patient rating of GPs.

According to The Times, Mr Javid has written to Prime Minister Boris Johnson stating that he has “an ambitious agenda that has the potential to be a central plank of your domestic policy legacy”. He has promised an independent review of general practice, stating it will look at workforce, business modes and how GPs work with other parts of the NHS.

The letter stated: “Whilst there are some strengths to the system of primary care, it’s also clear that the historic separation of general practice from the wider healthcare system as created in 1948 comes with considerable drawbacks including an underinvestment in prevention.” The letter links the plan to an earlier proposal for a new class of “reform trust,” which would take over struggling health areas. The letter states they would “drive innovation” bringing together primary and secondary care. According to The Times’ sources, the switch would be achieved by introducing incentives for doctors to hand their practices over to other organisations.

BMA GP committee chair Dr Farah Jameel described the leak as a “kick in the teeth.” Dr Jameel said GPs were “pioneers of innovation.” She said: “After the year we have had, the way general practice has pulled together through the pandemic, the hard work we’ve all put in, it was a kick in the teeth to read about our future in the press with no warning.

“We would of course like to see details of the plan and we’re open to working in partnership on an independent review of primary care. Indeed, we are calling for a new contract. Over the past year we know that the equivalent of three million patients lost their GP which is a serious situation that must be tackled. Covid-19 has laid bare the enormous workforce crisis, we cannot import our way out of this problem, neither can we train our way out of this problem. But it’s crucial to remember how good general practice is for individual patient care. Continuity of care delivered in general practice has been shown to be associated with lower mortality rates, fewer hospital admissions, less use of Emergency Departments and fewer referrals for specialist healthcare. Yet, this high-quality, cost-effective, and timely care is underestimated and poorly valued by policymakers.”

Dr Lizzie Toberty, GP lead for the Doctors’ Association UK, said: “Once again we are seeing futile distraction in the face of grim reality. The problem facing general practice is one of retention, not how it is organised from the top down, yet again. People want continuity of care – they want to see a familiar face over the years when asking for help from a GP. But there are fewer GPs then there have ever been – and we are asked to offer more appointments than ever. It is no surprise that fewer people are opting to come into general practice and growing numbers are choosing to leave it. Waving the magic ‘let’s reorganise this and see what happens’ wand will do nothing to alter the maths – and the tidal wave of misery it represents.”

Royal College of GPs chair Professor Martin Marshall said: “We are open to exploring new ideas about the future of general practice, but there has to be a very good reason for changing a model that works well for patients, for the NHS and for the taxpayer. The root of the pressures facing the general practice service, and the impact this is having on the care we’re able to provide for patients, is historic underfunding and poor workforce planning. What needs radical thought is the Government’s plans to make good on its manifesto pledge of an additional 6,000 GPs and 26,000 additional practice staff by 2024, so that GPs and our teams can continue to deliver the care our patients need and deserve, now and in the future.”