GP practices are, and always have been, the backbone of our health service. The trusted relationships with patients, built up through generations, provided that sense of security and safety that your GP was there for you, to help you and support you, and to prevent things from getting worse.
That old traditional perspective of the GP coming to your house to help, being there on the end of a phone when you need them, has, however, long since gone.
The reality of day-to-day GP working life has changed dramatically, with a recent study published in BMJ Open, highlighting that GP numbers have fallen by 20% in the last decade while their practice lists have increased by 40%.
The consequences of this from a patient experience and satisfaction perspective as well as the work life and job enjoyment and satisfaction balance for the GP are obvious, and more can be found on this in the BMJ Open article.
One area that has not been widely considered, in terms of the impact of these changes to general practice, is the impact on the reduction of social value being delivered by GPs, which will, inevitably, lead to greater pressures on acute services and a reduction in health and wellbeing in local communities.
There is no one overarching definition of social value, it all depends on what you’re looking to achieve through your organisation or activities. There is a widely understood process though, of aligning to the UN Sustainable Development Goals.
These globally recognised goals help to set the framework for organisations to develop their social value definitions and principles and the key areas to focus on are essentially: social, economic and environmental.
Patients visit their GP as the first port of call when initially troubled or worried about something. These early interventions can be crucial in picking up something potentially sinister, or in reassuring the patient and thus enabling them to get back on with their life.
GPs though, do much more than alleviate worries and concerns in these instances. They can support people through social prescribing, helping to deal with hidden, or understood, mental health issues, unlocking potentially years of struggle and upset.
Social prescribing – an approach that connects people to activities, groups, and services in their community to meet the practical, social and emotional needs that affect their health and wellbeing – has been around since the early 2000’s but has really come into common usage since 2019 when it became part of national health policy. Part of enabling this was the introduction of the additional roles reimbursement scheme, which has brought more than 3,500 link workers into post. More information on this can be found on the NHS England website.
As we have moved towards an increasingly medicalised approach to healthcare due to patient demands and pressures on GPs to get through each appointment quickly, there is also the impact of the reduction of social value being delivered through reducing numbers of GP practices – which is already being experienced more starkly in rural communities due to issues including poor transport links, ageing population and distance from services – such as pharmacy etc.
GP’s can deliver social value to their patients, communities, workforce and wider society through the work that they do. The application of social prescribing, as mentioned above, is one obvious way that social value is delivered. People can be prescribed to go for a walk, take up exercise, access cognitive behavioural therapy (CBT) services, have access to work based counsellors etc. The social value delivered through social prescribing will be felt by the individual, their family, the wider community and wider society as a whole, if, for example, an individual has CBT and is able to go back to work after a long period of being out of work.
As well as the social value delivered to patients, GP Practices themselves can also deliver social value through their own behaviours and activities. In 2024, Cheshire and Merseyside ICB coproduced the 10 Point Green Plan for Primary Care, building on an earlier document created by the Cheshire and Merseyside Greener Practice Group. This sets out a framework for GP Practices, as well as the wider primary care sector, to follow to increase their social value, reduce their carbon footprint, increase efficiencies and reduce costs.
Simple things like reducing the practices display energy certificate (DEC) to reduce energy costs or making small changes to prescribing methods, as 48% of primary care’s carbon footprint comes from prescribing pharmaceuticals. For example, metered dose inhalers (MDIs) make up a significant proportion of primary care greenhouse gas emissions. Switching to prescribing preventer inhalers, which are often low emission dry powder inhalers (DPIs), will significantly reduce the carbon footprint. Similarly, switching suppliers for greener goods and services will help to reduce costs and improve environmental outputs and promoting active travel – for the workforce and patients – will reduce carbon in the atmosphere but also increase activities and thus, health, for those who engage in it.
Most importantly though, is the opportunity to engage with colleagues, partners and patients to help to refocus how we access GP services. Modern society is based on having everything immediately – which includes our health services, which is becoming increasingly more medicalised. We want there to be an immediate solution for our aliments and can, often unknowingly, put additional pressure on our GP to request a tablet to fix everything, with the focus purely on the outcome for today’s ailment, and not the impact on the body in the long term. Changing behaviours – such as reducing the levels of red meat in your diet, increasing activity levels, increasing social activities and reducing negative habits, can all help to improve day-to-day lives of patients and are a big part of the social value that is delivered by our GPs, through conversations with patients.
All these positive impacts and outcomes being delivered by GP practices, increasing social value will all be undone, should the worrying trend of reducing GP numbers and increasing patient lists continue. Society needs to take a look at itself and ask what do we actually want from our health services and how do we enable ourselves to become more focused on supporting ourselves and less reliant on other people fixing our problems for us.
The announcement of the abolishing of NHS England on March 13 also puts a fresh perspective on the importance of primary care, following the recommendations made in the Darzi report. This new approach could put primary care in the position to support the societal changes needed in order to allow the longevity of the NHS.
Becky Jones specialises in social value and has advised Cheshire and Merseyside Integrated Care Board on the sustainability, social value and anchor work there for the last four years.
