We held a scenario generation workshop with stakeholders on 29 November 2012 to develop four plausible future scenarios to 2030, focusing on high impact, high uncertainty drivers of requirements of the GP workforce.

1. The CfWI produces quality intelligence to inform better workforce planning
that improves people’s lives
General practitioner in-depth
review
Scenario generation workshop outputs
Centre for Workforce Intelligence

2. 2
Background
The Centre for Workforce Intelligence (CfWI) has been jointly commissioned by
Health Education England (HEE) and the Department of Health (DH) to
conduct an in depth review of the general practitioner (GP) workforce. The
review will consider current workforce supply and the key drivers of future
demand for GP services and future supply.
We held a scenario generation workshop with stakeholders on 29 November
2012 to develop four plausible future scenarios to 2030, focusing on high
impact, high uncertainty drivers of requirements of the GP workforce.
The scenarios are not intended to be exhaustive nor necessarily ‘likely’, but
rather a plausible range of ways the future could unfold.

3. 3
Approach
The workshop participants identified a wide range of driving forces that could
impact the GP workforce in England up to the year 2030. By looking for causal
and chronological relationships, participants clustered the driving forces to
produce higher-level factors.
Assessing the clusters for level of impact on the GP workforce and degree of
uncertainty, workshop participants agreed on two high-impact and low-
predictability clusters to use in the scenarios:
 Attractiveness and status of the profession
 Patient vs. professionally driven workforce development

4. 4
The scenarios
Happy GPs,
excellent patient care
Right plan,
but wrong tools
GPs good,
commissioners bad
Meltdown in care
Professionally
driven workforce
development
Patient driven
workforce
development
Increase in status/attractiveness of
general practice
Decrease in status/attractiveness of
general practice

5. 5
Happy GPs, excellent patient care
Happy GPs,
excellent patient care
Right plan,
but wrong tools
GPs good,
commissioners bad
Meltdown in care
Professionally
driven workforce
development
Patient driven
workforce
development
Increase in status/attractiveness of
general practice
Decrease in status/attractiveness of
general practice

6. 6
Happy GPs, excellent patient care
 Widespread public consultation launched to agree case for change in primary
care. Consensus emerged.
 Recognition that care is best delivered by a content and motivated workforce
led to greater remuneration and flexibility of status.
 Increased investment in education and training helped make general practice
more attractive, recruitment increased. Retirement bulge avoided and
retention increased.
 Introduction of increased number of roles for the programme GP with a
Special Interest (GPwSI) helped improve interface between primary and
secondary care.
NOW 2020 2030

7. 7
Happy GPs, excellent patient care
 Increased media and public concern over size of budget. New arrangement
held firm due to continued strong public involvement in decision making.
 Services (such as MRI scans) increasingly delivered in the community.
 A better interface between primary and secondary care due to more varied
training.
 Increase in multi-professional working helped deliver cost savings.
NOW 2020 2030

8. 8
GPs good, commissioners bad
Happy GPs,
excellent patient care
Right plan,
but wrong tools
GPs good,
commissioners bad
Meltdown in care
Professionally
driven workforce
development
Patient driven
workforce
development
Increase in status/attractiveness of
general practice
Decrease in status/attractiveness of
general practice

9. 9
GPs good, commissioners bad
 After the largely successful implementation of CCGs and LETBs, a new GP
contract was put in place in 2015. This allowed changes in remuneration and
more flexible working opportunities.
 Evidence began to surface that the healthcare needs of the population were
not being met, possibly due to working in a financially constrained system and
poor commissioning decisions.
 The press picked up on this story and public support for GP commissioning
dropped.
 Politicians blamed GPs for making poor commissioning decisions and
reflected a public backlash.
NOW 2020 2030

10. 10
GPs good, commissioners bad
 A change in government meant that the power to commission was removed
from GPs, and commissioning bodies (similar to the former primary care trusts
(PCTs) were reinstated.
 New leadership emerged from the GP workforce, who wanted to focus much
more on the delivery of care.
 The refocusing of GP attention to clinical issues and of delivering care meant
that clinical services were improved, as was the public perception of GPs. They
became seen as important navigators of care pathways for patients.
NOW 2020 2030

11. 11
Right plan, but wrong tools
Happy GPs,
excellent patient care
Right plan,
but wrong tools
GPs good,
commissioners bad
Meltdown in care
Professionally
driven workforce
development
Patient driven
workforce
development
Increase in status/attractiveness of
general practice
Decrease in status/attractiveness of
general practice

12. 12
Right plan, but wrong tools
 The implementation of LETBs led to increased spending on continued
professional development (CPD) and training and education successfully
becoming aligned to patient needs.
 Contractual issues emerged that reduced GP flexibility, with regionally
determined pay and working conditions.
 The profession was less attractive, and the status was lowered.
 GPs became disillusioned with healthcare services and widening health
inequalities, and problems with delivery were observed.
NOW 2020 2030

13. 13
Right plan, but wrong tools
 In the 2020 election, the opposition party pushed for radical reform of primary
care. An increase in privatised healthcare services was observed.
 New policies subsequent to this reform led to a plurality of healthcare
provision, and consequently a fragmented training system.
 The number of different providers led to increasingly complex issues of GP
supply, and of the planning of education and training. This lowered the morale
of GPs, meaning lower recruitment and a significant gap in primary care.
 Demand for GP services continued to increase, while the supply decreased.
NOW 2020 2030

14. 14
Meltdown in care
Happy GPs,
excellent patient care
Right plan,
but wrong tools
GPs good,
commissioners bad
Meltdown in care
Professionally
driven workforce
development
Patient
workfdriven orce
development
Increase in status/attractiveness of
general practice
Decrease in status/attractiveness of
general practice

15. 15
Meltdown in care
 The new LETBs suffered from a lack of cooperation and did not plan or invest
funds in training strategically. Repeated attempts to address this saw a
piecemeal approach to skills development and training strategies.
 The federated model initially proved attractive to CCGs, but CCGs buckled
under the weight of imposed contractual changes.
 The patient voice became more assertive through the use of Quality Outcome
Framework targets. Competencies had been defined by interest groups, and
were poorly designed.
NOW 2020 2030

16. 16
Meltdown in care
 Due to poorly designed competencies and training, doctors in training were
mismatched to system demand. A scramble for jobs ensued, with increasing
numbers failing to find work in general practice. Numbers in medical schools
dropped.
 Pay and morale fell in medicine as perceived status dropped. Pressure on
medical education training budgets meant lower-quality training and higher
fees. A decline in leadership compounded the decline in status.
 A fractured, siloed approach to training, and continuing contractual issues
meant there was a perceived decrease in flexibility. The quality of recruits
decreased, and regional recruitment inequalities increased. Provision of care
was in meltdown, general practice became an unattractive career, and
patients were disillusioned.
NOW 2020 2030

17. 17
The scenarios
Happy GPs,
excellent patient care
Right plan,
but wrong tools
GPs good,
commissioners bad
Meltdown in care
Professionally
driven workforce
development
Patient driven
workforce
development
Increase in status/attractiveness of
general practice
Decrease in status/attractiveness of
general practice

18. 18
Additional scenarios
Early feedback from stakeholders suggested it may be useful to give further
consideration to the increasing role of technology in healthcare, and the
impact of this on the GP workforce.
To this end we have included two additional scenarios here, which were
developed at a similar scenario generation workshop focusing on healthcare
sciences. We have adapted these scenarios slightly to ensure their relevance to
general practice.
 Technology through regulation – high regulation of technological developments,
reliable products with public buy-in.
 Rise of the machines - low regulation of technology developments, unreliable
products.

19. 19
Technology through regulation
Technology through
regulation
Rise of the machines
Reliable
products with
public buy-in
Unreliable
products without
public buy-in
High regulation of technological
developments
Low regulation of technological
developments

20. 20
Technology through regulation
 Continued financial constraints meant legislators and civil servants looked
towards technology to provide cost savings.
 A consensus was reached among stakeholders, whereby technology would be
introduced, underpinned by a robust regulatory structure. A non-
departmental public body was set up to provide licenses to products, after
rigorous testing.
 Health technology modules were introduced to training for healthcare
professionals, and GPs helped design high-quality products.
 A stable health system was maintained, and products helped people self-
diagnose and self-manage their conditions.
NOW 2020 2030

21. 21
Technology through regulation
 By 2025, public and media frustration grew at a system perceived to stifle
innovation.
 After initial caution, the products were trusted, and empowered patients
demanded more.
 The regulatory agency responded to these issues by increasing public
participation in decision making.
 A large primary care workforce was still needed, with face-to-face
consultations remaining at a premium.
NOW 2020 2030

22. 22
Rise of the machines
Technology through
regulation
Rise of the machines
Reliable
products with
public buy-in
Unreliable
products without
public buy-in
High regulation of technological
developments
Low regulation of technological
developments

23. 23
Rise of the machines
 Public awareness of technology in healthcare increased, and legislators
responded to this by offering commissioners incentives to invest in
technology to allow patient self-monitoring.
 The role of 'healthcare technician' was heavily expanded, with only basic
certification needed. This meant that many GPs and practice nurses found
themselves out of work.
 Investment in the GP workforce decreased, as patients were able to diagnose
and manage their conditions themselves.
 Fierce lobbying from the technology industry meant that a 'light-touch'
regulatory model was adopted.
NOW 2020 2030

24. 24
Rise of the machines
 Development steady until around 2022, with public buy-in of the products.
 A series of mergers led to three major companies providing telehealth
applications to GPs. The market became less competitive.
 A loss of competitive edge meant less money was spent on research and
development. Applications became unreliable, and misdiagnosis common.
 Public trust in technology broke down, and the public reverted to valuing face-
to-face consultations.
 The cuts made a decade earlier meant that primary care services were ill-
equipped to handle these remodelled public attitudes.
 Primary care services found themselves tied in to costly long-term contracts
with technology companies, and could not service their patients.
NOW 2020 2030

25. 25
Technology scenarios
Technology through
regulation
Rise of the machines
Reliable
products with
public buy-in
Unreliable
products without
public buy-in
High regulation of technological
developments
Low regulation of technological
developments

26. www.horizonscanning.org.uk
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