|Happy new year to you – I hope you managed to get some well-earned rest during the festive period, before returning to the challenges of the year ahead.
We have entered 2017 with a health service overstretched well beyond capacity, which affects patients across the spectrum of GP surgeries, community services, hospitals and social care. Yet we also have a Government – borne out of a Brexit vote – unwilling to recognise this desperate need for more money, with the notable absence of any mention of the NHS in the chancellor’s Autumn Statement.
The prime minister continues to ignore the pleas for more funding from the Commons health select committee and NHS England chief executive Simon Stevens late last year, as well as from the Red Cross only last weekend. The BMA, alongside almost all other authoritative opinion, will lobby for this to be addressed in 2017 on the back of growing public awareness of the disconnect between political rhetoric and reality.
While media publicity has focused on hospital pressures, I have been emphatic that general practice is suffering under equal strain. I responded robustly in The Independent to the health secretary’s suggestion that the emergency care burden should be shifted to general practice. I highlighted that family doctors are already being worked ‘flat out’ and that ‘GP services are already overstretched and at full capacity, with one in three practices reporting doctor vacancies leaving many GP practices struggling to provide the necessary care to their patients’.
The crisis affecting general practice was restated in today’s National Audit Office report on access, which has highlighted that we are likely to have 1,900 fewer whole-time GPs by 2020 compared to the Government’s targets. The report is damning of ministers’ proposals to extend access using inadequate resources, with the chair of the Commons public accounts committee stating that ‘the Government is trying to shoehorn in seven-day access to general practice without a clear idea of the additional costs or benefits it will bring patients or taxpayers’.
It is vital that practices take active measures to manage workload to safe limits. I strongly recommend GPs and staff make use of the BMA GPs committee’s Quality First web resource, which is continually updated with tools to support practices to cease inappropriate and under-resourced work, manage demand, and work in different and effective ways.
A priority for GPC in 2017 is to ensure that all the promised funding and commitments in the GPFV (GP Forward View) are fully delivered to support the frontline – it is vital that this money is not squandered or diverted elsewhere. GPC is represented on NHS England’s GPFV advisory group, and we have set up a policy group to hold NHS England to account and track spending.
Given that much of the GPFV will be locally delivered, we have also set up a local medical committee reference group to monitor local implementation, and feed back any problems. GPC will also continue dialogue with NHS England on our Urgent Prescription for General Practice proposals to ensure safe working and stem the inappropriate workload shift from secondary care.
GPC has long advocated practices working together in collaborative alliances, to support each other to reduce workload and create resilience. Our recent survey shows that more than half of GPs support working more closely including with multi-professional staff. The GPFV proposes a £171m transformation fund that will start in April 2017 and is designed to support practices to work at scale. I suggest that you begin these conversations now on how you may wish to bid for this resource locally. Contact your LMC and CCG (clinical commissioning group) for guidance. GPC is also holding a special event next month on collaborative working – from federations to super partnerships – to support LMCs with local changes.
GPC has produced guidance on all the funding streams in the GPFV in our focus on funding and support for general practice and a checklist to assess CCG plans for delivery on the GPFV.
While it will inevitably be a challenging year ahead, GPC will continue to provide resources to empower you as GPs to take more control of your workload. We will also vigorously argue and campaign for general practice to be given the funds to do our jobs properly, with the hope that we can finally turn an important corner in 2017.
With best wishes,
BMA GPs committee chair
|Guidance for GPs on patients presenting with dental problems
We have created guidance for GPs on patients presenting with dental problems, which informs GPs of their obligations to patients either requesting emergency dental treatment or asking for an NHS prescription for drugs recommended by private or NHS dentists. It is aimed at all GPs including out-of-hours practitioners.
This guidance is produced in light of the growing number of patients seeking dental advice from GPs. A recent study in Wales found a typical general practice can expect to see between 30 and 48 patients with dental problems a year. The British Dental Association estimates that this costs the NHS £26m a year.
This guidance will help you to manage the pressures caused by that demand. I would like to express my particular thanks to Peter Horvath-Howard from GPC who has led on this area of work.
|Payment secured for NHS SBS incident
|GPC was informed of an issue in April 2016, which had been identified by NHS SBS (Shared Business Services), who previously provided primary care support to GPs in a number of areas across England.
SBS had identified a warehouse of patient-related information that it should have transferred to practices for processing, but failed to do so. These items require returning to practices to review and assess for clinical harm.
This error from SBS – a private company contracted by NHS England – has caused, and will continue to cause, extra workload for practices during the coming months, and is another example of the detrimental effects of outsourcing work.
GPC has worked with NHS England to secure appropriate payment for the extra work associated with the return and assessment of these items. Practices will receive payments related to the number of items received.
NHS England has also agreed to support practices through this process with a dedicated phone line and email address. It will provide draft letters to patients, if required.
Find out more here
|Applications for funding to recruit clinical pharmacists
GPFV committed £112m of investment to support an extra 1,500 clinical pharmacists in general practice. This is in addition to more than 490 clinical pharmacists already working in general practice as part of a pilot, launched in July 2015. The first cohort of successful participating providers will be announced in March 2017.
Clinical pharmacists are designed to be part of the general practice team to resolve day-to-day medicine issues and consult with and treat patients directly, with the aim of reducing the workload burden of GPs.
Providers participating in the programme will receive funding for three years to recruit and establish clinical pharmacists in their general practices. Further details of how to apply to the programme can be found on the NHS England website.
Focus on the MCP contract
As some of you may be aware, NHS England has now published the draft version of the MCP (multispecialty community provider) contract and associated guidance documents on its website, and is taking comments on the draft documents until 20 January. This will be followed by the release of a revised version of the contract followed by a formal consultation later in the year. This has been developed over the past year by NHS England via the MCP contract development group.
Practices are reminded that any local MCP contract is entirely voluntary for practices.
There is a choice of three MCP models – virtual, partially integrated and fully integrated. Following successful lobbying by GPC, two of the three options (virtual and partially integrated) allow GP practices to retain their national contract, while still benefiting from greater integration of services. Only the full integrated MCP model involves practices giving up their national GP contract and entering into a local time limited contract within the MCP.
GPC believes that there are serious risks of practices leaving their national contract, and which would mean losing national representation, and that it would also be very difficult to return to previous arrangements thereafter. Practices should therefore not feel pressured to enter any one of these models by local commissioners, and be assured that there remains a multitude of options for practices within their current national contract looking to work collaboratively other than in MCPs, such as in super practices, federations or networks. Read more about working collaboratively in our BMA web pages.
Further information on MCPs can be found in our ‘Focus on the Draft MCP Contract’ which summarises the models, our position and concerns. Further detailed guidance on the draft contract will follow in due course. In the meantime you can read a blog on MCPs by Gavin Ralston (GPC executive lead) on ‘what does the MCP contract really mean for GPs?’, and we would encourage practices with any questions over the proposals to contact their LMCs.
| The Primary Care Foundation’s bureaucracy survey for practice managers
A year ago, the PCF (Primary Care Foundation’s) Making Time in General Practice survey sought to tackle the increasing workload in general practice.
NHS England has now commissioned the PCF to look again at the bureaucratic burden on practices with a survey of practice managers, which can be accessed here. This seeks feedback about how practices are paid, contact with hospitals, as well as the full range of tasks that take time and divert energy away from patient care. The last survey led to immediate changes and this time there is an opportunity for you to meet up with national leaders.
Thank you for distributing the survey link as widely as possible to your colleagues and encouraging your practice managers to complete it.
| GPC in the media
GPC has received considerable coverage in the national and regional media over the last week.
In addition to my response yesterday in The Independent to the suggestion that the emergency care burden should be shifted to GPs, The Sunday Express reported on our quality first campaign to reduce the amount of time spent tackling unnecessary GP appointments and bureaucracy, with an estimated 15m appointments wasted in this way.
Last Friday, following the announcement that NHS England is to introduce an app that offers people medical advice on their smartphones, I was widely quoted in The Guardian, The Telegraph, The Sun and The Daily Mail as saying that, ‘this initiative does not address the fundamental problem that we have a severe shortage of GPs and health professionals in community settings. What we should instead be doing is investing in having properly trained and appropriate clinical staff handling calls and requests from patients, complementing the use of new technologies’.
Also last week, BMA GPs committee deputy chair Richard Vautrey featured in The Times, The Guardian, The Daily Mail, The Independent, and iNews and a large number of regional publications following a BMJ investigation revealing that NHS organisations pay millions of pounds to referral management schemes, often run by private firms, that screen patients being referred to hospital by their GPs, saying that ‘CCGs are leaping at these schemes without any clear evidence of benefit and that they’re just hopeful that it might reduce their costs. It is a very, very short-term approach to healthcare management’. I was also filmed by the BBC on this subject yesterday with the intention of this story being broadcast next Monday.
On Wednesday, Dr Vautrey was quoted in The Daily Mail following a report on figures by NHS Digital revealing that the number of patients registered with each GP practice has risen by up to a third in the past three years. Dr Vautrey warned that the crisis would intensify as another 300 practices are at risk of closure following a recent BMA survey