2016: A year in general practice

The GP Forward View, STPs, practice closures, mass resignations (or not), Brexit buses and the junior doctors' strikes - 2016 was an eventful year for general practice and the NHS. GPonline looks at the key events.

January

The start of 2016 brought with it a reminder of why morale across the medical profession was at rock bottom.

On 12 January junior doctors staged the first of a series of walkouts (the first strike action by junior doctors for 40 years) after negotiations for a new contract between the BMA and the government collapsed.

Meanwhile, at the end of the month, GP leaders held the first special LMCs conference in a decade to debate the crisis facing general practice. After a passionate debate delegates overwhelmingly backing a motion calling on the GPC to canvass the profession on their willingness to submit undated resignations in a bid to force the government to deliver a ‘rescue package’.

The conference also backed motions calling for a new contract for care home patients, help with indemnity costs and a workload cap and 15-minute consultations.

February

The Scottish GPC confirmed the QOF would cease to exist north of the border from April.

A BMA poll of almost a third of practices in England found that over half said the service they were providing was deteriorating due to workload pressures. 

NHS England revealed it was ‘scoping out’ plans for a service to help GPs facing burnout and stress planned for launch at the end of the year. The service now looks set to launch in Jaunary 2017.

Local authority budget cuts have been in the spotlight recently because of social care funding, but back in February a GPonline poll found that public health has also been hit. A third of GP partners said public health services at their practice had been reduced since commissioning was taken over by local authorities in 2013.

There seemed to be no end in sight to the junior doctors’ dispute as medics staged a second 24-hour walkout. Health secretary Jeremy Hunt responded by saying he would impose the new contract on junior doctors, leading the BMA to escalate the strikes with three 48-hour walkouts by non-emergency doctors planed for March and April.

March

The scale of the crisis in general practice was laid bare by figures obtained by GPonline which suggested more than 20% of practices in parts of England had been identified as ‘vulnerable’ by NHS officials. The figures were backed up by a BMA poll of almost 3,000 practices in which 10% said they were financially unsustainable and 20% said they were in a weak financial position

The CQC announced that fees for GP practices would triple from April, causing an outcry from the profession.

During the first 48-hour junior doctors strike doctors leaders called on prime minister David Cameron to step in and resolve the dispute. Meanwhile a group of junior doctors called Justice for Health, including two GP trainees, launched a crowd funding appeal to start a legal challenge over the government’s plans to impose the contract.

April

On 1 April Manchester became the first region in England to take full control of health and social care in a £6bn devolution deal.

A study in the Lancet found that between 2007 and 2014 GP workloads had risen by over 16%. Later in the month the then health minister Alistair Burt admitted that GP workload ‘may be increasing’.

The BMA demanded an ‘urgent’ £2.5bn investment to end the GP crisis and less than a week later NHS England responded with it’s GP Forward View, which the RCGP hailed as the ‘most significant GP deal since the 1960s’.

The GP Forward View claimed that annual GP funding would rise by at least £2.4bn a year by 2020/21, taking the share of NHS funding spent on the profession to around 10%. However, many grassroots GPs were critical of the plans, which they said did little to address the current problems of underfunding and contained very little detail.

The junior doctors dispute rumbled on, with a second two-day walkout of non-emergency medics followed by the first all-out strike of junior doctors in NHS history later in the month. The Justice for Health group raised over £100,000 and launched legal proceedings against Jeremy Hunt and two junior doctors began an indefnite protest outside the DH demanding talks with Mr Hunt.

The term ‘sustainability and transformation plan’ made its first appearance on GPonline.

May

More than three out of five GPs said they did not believe the GP Forward View would end the crisis facing the profession, in a GPonline poll.

The GP Forward View was also front and centre at this year’s LMCs conference in London with delegates saying the extra funding would come too late to save general practice. Another passionate debate saw delegates again back calls to ballot the profession on their willingness to take industrial action and their willingness to had in undated resignations unless the government took steps to save the profession as set out in the GPC’s Urgent Prescription for General Practice.

The RCGP defended the GP Forward View, saying it was ‘good for GPs’.

The GPC warned that systemic failures in primary care support services, run by private company Capita, were posing a significant risk to patient care.

Jeremy Hunt became the longest-serving health secretary (although our top 10 shows three other men held the equivalent role for longer when it was called something else).

The BMA and government entered talks in a bid to avert further industrial action and resolve the stand-off. The talks resulted in a new deal agreed by both sides, which the BMA said would be voted on by junior doctors in early summer.

June

June 2016 will forever be remembered for Brexit – and the NHS certainly played a key role in the Leave campaign.

GP leaders in Northern Ireland warned that the service was on the ‘edge of a full blown crisis’.

GPs in England began referring patients to the new flagship NHS diabetes prevention scheme.

GPC chair Dr Chaand Nagpaul said that practice closures were at record levels. GPonline revealed that Virgin Care was set to take over an outstanding GP practice that was forced to close as a result of £400,000 cuts to its PMS funding.

July

Dr Helen Stoke-Lampard was elected as the next chair of the RCGP – to take on the role in November.

GP trainee data suggested that there had been a welcome surge in GP recruitment.

A poll by GPonline highlighted the problem of rising indemnity costs, with nine in 10 GPs saying costs had risen over the past year – 28% of these said their indemnity payments had risen by more than 20%. Later in the month NHS England unveiled a £60m fund to help address the issue (although the MDOs warned the problem of rising indemnity costs could not be solved by short-term funding).

NHS England also revealed early details of the new voluntary MCP contract. However, earlier in the month the Nuffield Trust had published a report showing that large-scale GP provider organisations had so far failed to improve quality and were linked with falling patient satisfaction. The study authors said NHS leaders should not ‘ let expectations of these new organisations run away from the reality’.

The GPC passed a vote of no confidence in Capita and its ability to run the primary care support service.

Junior doctors rejected the proposed new contract and the BMA demanded fresh talks with the government, but Jeremy Hunt confirmed he would impose the contract from October.

After Theresa May became prime minister, Jeremy Hunt survived as health secretary in an extensive re-shuffle – although it was widely reported that he’d been given the boot early in the process

August

The GPC scrapped plans to ballot the profession on mass resignation, after NHS England agreed to accept the BMA’s Urgent Prescription for General Practice as a ‘basis for further discussion' in a move that angered and upset grassroots GPs.

Scotland unveiled a £20k ‘golden handshake’ to attract GP trainees to hard-to-fill posts.

The GPC revealed that practices were missing thousands of pounds in GP trainee payments because of errors by the primary care support service run by Capita.

GP stress was in the headlines again as a survey by health charity Mind found that as many as one in seven GPs reported having experienced suicidal thoughts as a result of workload pressure.

GPonline revealed that NHS hospitals were still dumping work on GPs despite a change to their contract intended to prevent them doing this.

September

Problems with primary care support services Capita continued as it was revealed there were delays processing GP trainees applications to join the medical performers list

The former head of NHS England’s commissioning policy unit hit out at the ‘shameful’ pace of the STP rollout, saying it risked a financial meltdown. Early details from STPs suggested that the plans would look to move services into primary care and also aim to provide healthcare with less GPs. GPonline produced its first podcast looking at what STPs mean for general practice in England.

GPC Northern Ireland said it would ask the profession to consider mass resignation. Meanwhile GPC England was formed after GP leaders voted for the change at the LMCs conference in May.

Junior doctors called a wave of five-day strikes to run through the rest of 2016. However, the first of the strikes was suspended after NHS England warned it needed longer to prepare cover.

The move was the beginning of the end of the industrial action and the BMA later suspended the remaining five-day strikes amid reports of a division within the BMA council and following concerns from the royal colleges and patient groups.

Justice for Health lost its High Court case against Jeremy Hunt’s contract imposition.

October

Professor Maureen Baker (above) bows out as RCGP chair after three years in post, delivering her last address at the college’s conference in which she says that STPs that fail to invest in general practice should be rejected. Professor Baker also says that more needs to be done to stop the denigration of general practice and encourage medical students to choose the profession.

Jeremy Hunt unveiled plans to end the NHS's dependency on overseas doctors at the Tory party annual conference. He said new doctors will be obliged to work for the NHS for a minimum of four years after graduation and said there would be an additional 1,500 places at medical schools from 2018.

The Scottish government announces that general practice in Scotland will receive 11% of the health budget by 2021. Meanwhile NHS England announces the next wave of funding from the GP Forward View for infratructure, indemnity and mental health.

Health Education England reveals one in 10 GP trainee posts is vacant for 2017 despite the recruitment boost seen earlier in the year.

The GMC’s annual report highlights ‘intolerable pressure’ on doctors saying that levels of dissatisfaction in the medical profession are 'higher than ever before'.

The chair of the health select committee, former GP Dr Sarah Wollaston, and other members of the committee call out the government on its claim that it has given an extra £10bn to the health service and ask chancellor Philip Hammond to consider extra investment in the NHS and social care in his autumn statement (which he doesn’t do).

November

New RCGP chair Dr Helen Sokes-Lampard (above) speaks exclusively to GPonline. In a wide-ranging interview she says that GPs must accept that change is inevitable and warns that the balance between incentives for GP locum work compared with partnership or salaried roles must change to stop the exodus from longer-term general practice jobs.

GPonline reveals that practices serving more than 5m patients in England could be forced to close in the next year after a poll suggested that one in 10 GPs believe their practice was at risk of closure.  Meanwhile a BMA survey finds that eight out of 10 GPs in England believe their workload is unmanageable.

Health Education England publishes a landmark report calling on the DH to urgently review medical school funding to improve training in primary care and tackle the perception of general practice being a 'less valued' career option.

GPonline, perhaps unsurprisingly, reveals that GPs are ditching partnership roles to start locum careers – around one in six GPs who describe themselves as locums were partners a year ago.

The Capita debacle continued, with the government saying the company should consider compensation for GPs affected by problems with the primary care support service. Meanwhile the GPC said practices should take legal action over missing trainee payments or payment information.

Health minister David Mowat reveals that 1,000 practices will receive support this year through the General Practice Resilience Programme.

The BMA surrenders its junior doctor contract strike mandate.

December

Jeremy Hunt pledges to ‘bang the drum’ to persuade medical students to choose general practice careers.

The GMC says all doctors should be trained using a 'more flexible approach' so that they can work in general practice and help meet growing demand from older patients with multimorbidity.

It looks increasingly likely that GPs in Northern Ireland will be asked if they back mass resignation in the new year.

GPC chair Dr Chaand Nagpaul says practices must be prepared to refuse unfunded and inappropriate work after the campaign group GP Survival published an open letter to him warning that the profession was 'being decimated' and that unfunded GP workload 'had to stop'.

The RCGP says that its amabassadors, employed to represent GPs in the development of STPs, have been blocked from seeing the emerging proposals. The GPC sends a checklist of GP Forward View spending commitments to LMCs to help local GP leaders challenge CCG spending plans, which are currently being drawn up.

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