Our very own Michelle Sinclair has written a review of the GP Forward View for the BMJ, which can be read here.
A Joint Response to the General Practice Forward View
- Urgent measures are needed immediately to prevent the collapse of general practice
- Long overdue investment and a long term plan, but will practices last until 2020?
Whilst no one can dispute that it is good that the importance of General Practice within the NHS has been recognised, looking behind the headline £2.4 billion doesn’t instil most of us with the enthusiasm it seems to be causing elsewhere.
- It is not clear if this money is going to have to come out of the £8bn already promised to the NHS by 2020. If this is on top of the £22bn savings that have to be found, that doesn’t add up. Who is potentially losing out to give us the funding?
- £2.4bn would take us BELOW 2010 levels of funding for general practice. Surgeries need money now.
- Come 2020, we will have more complex patients, more GPs and allied healthcare professionals to pay (if they can be found) and more work to do. To get the full amount promised, GP surgeries will need to open every evening and 7 days per week. This is on top of the existing urgent care and out of hours service; a duplication which makes little sense.
- There is a £322m primary medical care allocation mentioned for 2016/17. Isn’t this what we had already been told we were getting or is it additional? We need urgent clarity.
- We are led to believe that the £508 million transformation fund is a one-off, and depends upon CCGs being able to fund much of it. CCGs have no spare money, many are overspent and/or having to prop up secondary care trusts. There is no mention or explanation of the context in which these headline figures translate into real investment for practices.
- NHSE and the RCGP have supported the creation of 5000 new GPs by 2020. Again – this is never going to happen.
- The GP returners’ programme (which was created by workforce planning at the GPC) is good but simply isn’t enough. The Parliamentary Select Committee Report released today calls for Government analysis and tracking of leavers and their reasons for departure – but it’s GPs leaving practices that are key – not a simplistic head count of those entering/leaving the profession. Not all GPs see patients in the classic surgery setting.
- Recruitment from abroad is an extraordinary plan when we can’t seem to tackle getting UK GPs back into the workforce without major difficulty.
- The significant challenge of medical indemnity fees is not addressed when this would make an immediate difference to the number of sessions GPs can work both in and out of hours. A chance to maximise the current workforce has been missed here. Funding needs to go directly into GP practices, so that they can keep the GPs they have, and recruit more.
- With regards to pharmacists and paramedics, when they work well with GP practices, it is good for everyone and we can be pleased that this may be expanded.
- The army of 1000 Physicians Associates however is somewhat less helpful. There are currently 35 working in general practice in the UK, with no regulation and no career structure. Today’s Select Committee Report calls for the regulation of physician assistants.
- The medical assistant role may however be something that actually makes a positive difference to the day to day lives of GPs.
The organisational structure
- Current surgeries need money now. This forward view is based almost entirely around large collections of GPs working together. Whilst this can work well in some areas, it by no means for everyone and, in fact, there have been recent thoughts that the Vanguard model may not be the panacea that it was once touted to be, again as iterated in today’s Select Committee Report.
This plan is very short on detail, and detailed immediate plans are what we need. There is a recognition of the issues, but a lack of urgency in a dire situation. We collectively are worried there won’t be a General practice to fund in 5 years’ time. If there is, it will be one that is not recognisable to our patients. Patients must be clear they will not be seeing a GP very often in the future, but other healthcare professionals. Has that been adequately communicated to them? Our funding is being taken away from other areas of the NHS and takes us back to less than we had in 2010. If the government and NHSE were serious about maintaining high quality General Practice for the rising population of the UK, this plan would include immediate emergency measures alongside the longer term vision. We look forward to seeing the GPCs next step in light of today’s report.
During our recent survey, Practice Index, a group set up to support practice managers, helped by promoting the survey through their networks. We asked them if they could write a blog for us on the role of Practice managers in GP. Read on….
At a time when hundreds, if not thousands of practices, are facing the very real threat of closure, now is the perfect time for GP partners to allow their practice managers to become the saviours of surgeries everywhere.
Unlike GPs, practice managers tend to come into the profession with a variety of skills and experiences, which can help primary care move into the new, service-focused world we all exist in. This means practice managers can be leading advocates of new ways of working and therefore well-placed to establish truly patient-focused, efficient services.
Practice managers also have a true understanding of what goes on across the whole practice, both front of house and behind the scenes. They’re the chief executives of practices. They know the practice budgets, have knowledge of where capacity is in the practice, can see where additional services can be added, understand where additional resource is needed and they’re also the conduit between practices and the never-ending dump of administration from the NHS and CCGs.
Now’s the time
So, it’s therefore time to utilise the skills of these experienced professionals, allow business skills to be brought into play and free-up practice managers to utilise the full range of systems, tools and resources available at the front line to the benefit of businesses; because that’s exactly what practices are.
For example, could technology be used to improve efficiencies and cut expenses concurrently? Many surgeries will still have a receptionist to book patient appointments, but their time could be better spent elsewhere. Communication takes many forms these days so why not let patients book their appointments online and by telephone.
Keeping up with the latest technology can also help practices to become more efficient and ultimately reduce expenditure. For instance, practices can save both printer ink and paper by sending invoices and statements electronically. Also, small changes such as switching to energy efficient light bulbs will go a long way for cutting your expenses too. While clinical staff concentrate on that side of the practice, it’s practice managers who can effectively implement changes, whatever they are.
Change is needed and inevitable and with the support of partners – and that is the key here – practice managers can drive practices forward, update processes, streamline operations, cut costs and boost revenues. They have the skills to save general practice so now’s the time to let them do just that.
Author: Practice Index