- Posted Monday May 2, 2016
Hot on the heels of the 'Five Year Forward View', we now have the General Practice Forward View - a specific plan to drive improvements in general practice that was published by NHS England in April 2016.
Here, Survindar Chahal talks us through the plans...
Recruiting more GPs
If we quietly side-step the ongoing junior doctors’ pay dispute, this report gives us plans on how NHS England will achieve Hunt’s plan to recruit 5,000 more GPs by 2020. Increasing the number of training places, a major international recruitment campaign, bursaries for those areas where it has been difficult to recruit and plans to simplify return to work processes to entice GPs back into the industry.
Practice staff Training
Funding will go towards training and development of practice staff - £6m for practice managers and access to a new ‘national development programme’, and £45m for reception and admin. The report stated that every practice will benefit from training its clerical staff so they can take more of the admin away from GPs, along with more investment in automation of some processes. There is also an extra £15m for practice nurse development, which will also include return to work schemes and increasing pre-registration placements.
Practices that have been rated as good or outstanding by the CQC will only be inspected every five years, an improvement on their current processes.
The LMCs have been calling for them to be scrapped altogether, which realistically will not happen at this time, but at least there is now a more manageable timeframe between inspections so that CQC can focus on the struggling practices. Interestingly, NHS England said they will cover the cost of any increase to the CQC fees in the GP Contract for 2016/17.
Looking at the report in more details, there were a few things that we noticed that raised a few eyebrows as well as questions…
There is an obvious absence of anything that would suggest a pay rise in this proposed package. The miserly 1% for public sector workers still continues (of course, this doesn’t apply to the MPs and their recently awarded 11%)
Although they mentioned that ‘Crown Indemnity’ was not going to happen, it seems they confused ‘Indemnity’ with ‘Immunity’. The call from GPs wasn’t to be immune from legal action, but to have an effective system in general practice similar to the ones that exist for those in secondary care that allows for better support and protection.
Finding the 5,000
This is a net figure, and they’ve clearly stated they want an 'international recruitment' plan (aka, “if you offer it, they will come”). Parachuting in foreign GPs like a scene from A Bridge Too Far won’t solve the longer-term problem, or even put them straight on the front line.
If they do come, they’re going to have to go through GP Specialty Training, an entrance assessment and then the GMC’s professional linguistic and assessments test before being released on the shop floor, so to speak. Health Education England signed a ‘Memorandum of Understanding’ with Apollo Hospitals in India to share clinical staff between them last December.
We already rely heavily on foreign doctors and nurses, so why can’t we recruit more of them in the UK? Why don’t enough people want to enter the profession? It’s probably a bigger question considering the rates of dissatisfaction and burnout of NHS frontline staff in particular, but it’s a wider debate that needs to be had.
Besides, can you really entice those people who’ve already left because of burnout, stress and disillusionment to come back to a profession that hasn’t fixed the problems that made them leave in the first place?
This is not new money
This is the funding that was promised by the Chancellor in autumn for the NHS as a whole, and the money has been shifted towards general practice. This means that there will be reductions in what goes to secondary care, mental health, community health, public health and specialist care. It is estimated that real-term spending on general practice had fallen £250m since the Conservative-Liberal Democrat coalition began in 2010.
Locum costs have skyrocketed over the last 5 years or so – some practices rely on them on a semi-permanent basis to give them stability in meeting demand, but as all practice managers know, it comes with a hefty price. NHSE say they will set indicative rates for locums, and practices can point out where they’ve had to pay over the odds so that they can see how much of a problem it is for practices.
Why wait till next March? All they have to do is look at the last few months of a practices’ locum spending to see that. Why wait until the next annual e-declarations to see that this is a real problem? Practice Managers know that it’s the patient demand and the loss of GPs that prompting the need for cover. When you’ve still not found a locum GP for tomorrow, and there’s one on the phone demanding over £100 an hour (plus travel and expenses), what would you do?
Looking at what has been promised (£900m over 5 years, Stamp Duty payments, help with NHS Property leases), it’s a step in the right direction. The new “Transformation Fund”, previously the Infrastructure Fund, only runs up to March 2019, with no real clarity on what happens after that, but it’s good news that NHSE will fund up to 100% of development costs instead of the old capped 66% rate.
For those practices that are tenants of NHS Properties, they will get help with stamp duty and land tax payments, for a limited time, and ‘transitional support’ for increased costs of facilities management. It just doesn’t say how long this transition will be, and if it is to encourage practices to lease from NHS Property Services, there’s the hefty service charge that goes with it.
The impact of these new Multispecialty Community Providers being trialled (sorry – ‘Vanguards’) is yet to be seen, but if it is rolled out then there might be the need for extra space in your practice, meaning extra cost.
Multispecialty Community Providers
There are 14 sites across the country trialling (again – ‘Vanguards’) this new clinical model for integrating primary and community care (see the NHS Five Year Forward View). The practice will hold a budget for the MCP services that will cover both, and they will focus on better population health management and more tailored to the regions’ needs, specifically targeting 10 minutes per consultation.
The way they’ve described it sounds more like clinical queue-busting – see the patients at the door, tell them if they need to see a doctor or not, and send them (sorry – ‘signpost’) them to another service, all within a few minutes.
If it’s done properly then it will be a good move – integrated care between GPs and nurses, pharmacists, therapists etc. to reduce delayed treatment or unnecessary hospital/A&E use.
What we’ll need to know is how it will be paid for, and what are the legal, contractual and payment options – what type of organisation are they, what contract options will there be and how will they get paid? Will they be paid as well as (or instead of) the GMS/PMS, something brand new to replace it, target-related pay like CQUIN or QOF, or will they create their own? Will it be another way in for private healthcare providers?
The interesting odds & ends
A few snippets were in the report, but with very little detail, that make us think something else will be happening, and worth watching out for in any future announcements from Quarry Hill:
“... a reformed 111 service”
“The national development programme”
“Practice resilience programme”
“Key ‘sentinel’ indicators for general practice"
For more information, why not check out our General Practice Forward View breakdown?