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COVID, Brexit and the NHS Long Term Plan – is this ‘The Perfect Storm’ for GP Practices?

2020 ended in a flurry of activity across the board – lockdowns, vaccine rollouts, a Brexit deal, and a Tiered Christmas closed off a year that could be politely described as “eventful”.

This was also the year that the NHS Long Term Plan (LTP) would get in its stride and start implementing changes for practices to move to new ways of working – with so many factors in play, can the NHS deliver on this logistical challenge in 2021?

COVID-19: freeing up capacity along with ramping up the vaccination process.

Understandably, the priority for GP Practices is to deliver the various COVID vaccinations, with the government promising 13.9 million people in high priority groups by February 15th.

To help with this, NHS England published their letter to GP Practices (7th January) on how they intend to support Practices to support the COVID Vaccination scheme. A lot of people were saying there was pressure on general practice after the rollout of the COVID DES before Christmas, and how to focus on delivering this as well as the ‘business as usual’.

The letter directs the CCGs to take pragmatic action to support GPs and to enforce actions where necessary, such as suspending locally commissioned services and reporting and performance indicators. It does state that budgets for these services during this time should be protected, indicating that this may be paid in a different way or a later date; “budget payments against these services should be protected to allow capacity to be redeployed”.

There is also a recognition of the PCN Director’s responsibility for the COVID vaccination response, to co-ordinate the delivery of the vaccine. Where previously in Q4 there would be a payment of 0.25WTE for the PCN Director, which will be increased to 1WTE for those PCNs that have at least one practice taking part in the COVID-19 vaccination ES.

That money will not necessarily go directly to the Clinical Director, but “flexibly deployed by PCNs” - this could be surmised to recognise the extra effort to co-ordinate the programme, and potentially for any additional staff, secondments or backfill of practice staff that may have been needed.

Most of the points in the letter indicate where income will be protected;

  • The 8 prescribing indicators within QOF; instead payment will be made against past performance
  • Minor surgery income (since all non-essential procedures have been suspended by the NHS)
  • Quality Improvement domains will also be protected

GP Appraisals can also be postponed or declined, but if they are done then they should utilise the shortened format from the 2020 model, especially helpful for those GPs serving as Clinical Directors.

Extending access arrangements from April 2021

The document then elaborates on the 9th November letter about an additional £150m covid fund for CCGs to disperse to their practices to support the primary care effort. The scheduled move to PCNs being in control of extended access as the Network Contract DES won’t be moving to PCNs before April 2022, which is understandable as it would be a struggle under the current circumstances to put effective new arrangements in place.

In preparation of this many practices and groups have been transitioning over to the PCN running this, however with the priority of the vaccination programme, this has been put on hold with an expectation that this will be revisited next April 2022 instead. This gives flexibility for the existing arrangements with practices and suppliers to continue with this and put plans in place for another 12 months.

Brexit

Last week, our HR Specialist talked about Brexit and the potential implications on workers’ rights, but there are also concerns in the UK media that staff shortages, obstacles to recruitment, and disruption of supplies of equipment & medicine will compound the pressures on frontline healthcare. NHS Organisations were advised to prepare for the transition period in the event of a ‘No Deal’ scenario, but there will no doubt be some cause for concern.

Immigration and the workforce

Leaving the EU ended free movement between the UK and EEA countries – as a whole, the NHS has a workforce of over 13% of non-British nationality, and 16% of the workers in adult social care. The points-based immigration system makes exceptions for most healthcare professionals (as long as they have a job offer with an NHS provider) who will be issued with a Health and Care Worker visa.

A qualified doctor, nurse, healthcare professional, or adult social care professional with a job that is eligible for the visa will need to be paid at least £20,480 per year unless the ‘going rate’ is higher than this (applicants or their employer will need to provide evidence).

This will inevitably mean that for any recruitment of non-UK employees, practices will need to review their employment needs and ensure their recruitment practices are following government guidance.

Medicines and Medical devices’ supply

The UK imports £18 billion worth of medical products from the EU, twice the amount that we export to the same market. Pharmaceuticals are regulated by the European Medicines Agency (EMA), which meant we only needed a single licence.

Now we are no longer part of the EU, there will be additional checks in the UK and EU before medical products will be able to cross the borders, which inevitably means delays to accessing the required stocks. The MHRA will take over regulatory duties of the EMA, and the government transferred EU rules into UK law (Northern Ireland will still be subject to the EMA).

This could mean delays and additional costs for certain goods – the government has assured healthcare providers that any disruption to medicines supply will be temporary, however, this depends on the new border operations, potential customs charges that may increase costs, new border checks, and customs paperwork which will all be required from now on.

The NHS Long Term Plan timeline still in effect?

Since it was first published in 2019, the Long Term Plan was the touchstone of developing the healthcare service for the next decade, but it is clear that with the pandemic still in force and millions of patients waiting more than 18 weeks for hospital treatment, the NHS has a major task to get back on track. Before COVID, the ability to deliver the LTP aims depended on the right funding, solving the staff shortages, and a reform of the social care system.

In November, the Chancellor announced that the NHS will be receiving an additional £3bn this year to help services recover after the pandemic. This includes £1bn to tackle the backlog of waiting lists for elective surgery, along with £1.5bn to ease existing pressures caused by the pandemic and £500m for improving NHS staff access to mental health services and investing in the NHS workforce.

Since the first lockdown of March 2020, some of the LTP ambitions were rushed into place, like digital consultations. Most GP appointments were still carried out face to face, but practices were instructed to discourage patients from visiting the practice physically to keep staff safe. It was a positive development from the pandemic response for general practice, albeit with a rush to implementation, but it was part of an acceleration towards integrating services with NHS organisations, local government, and the voluntary sector.

By 2023/ 24, Sustainability and Transformation Partnerships (STPs) / Integrated Care Systems (ICSs) will be delivering treatment to people using integrated, place-based approaches, underpinned by new investment.

Expecting the NHS to continue to deliver on the LTP would always be challenging, especially when it has been mobilised to deal with a pandemic to such an unprecedented level. The vision set out in the LTP garnered widespread support, and in the face of significant pressures – funding, staffing shortages, etc. – there is an expectation that there will be changes or delays in rolling out what was always an ambitious series of changes.


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