Delivery of GP Forward View 'confusing and inadequate', warns BMA

Implementation of plans to increase GP funding by £2.4bn a year by 2020/21 has been 'confusing and inadequate', a BMA progress report on the GP Forward View has warned.

The BMA analysis says that monitoring of investment in 2016/17 shows that 'funding and support is starting to make its way through to practices'. Further funding is due to materialise in the current financial year, the report adds.

But GP leaders hit out at 'unacceptable' delays to promised funding and uneven distribution, warning that many GP practices remain at breaking point and have been denied the 'certainty that they will get the resources necessary to deliver safe, effective care'.

A £220m increase in funding through the 2016/17 GP contract, plus a further £102m allocated by CCGs to cover population growth and local investment could deliver up to a £322m total rise in GP investment in 2016/17, the BMA report says. If this level of investment is confirmed in NHS Digital data on GP funding later this year it would mean a 4.4% rise in GP investment in 2016/17, 'representing almost 13.5% of the £2.4bn recurrent funding increase expected by 2020/21', the BMA report says.

GP workload

The report suggests that funding is also coming through to practices from a range of other schemes, including plans to ease GP workload through the GP resilience programme - which promised £40m over four years including £16m in 2016/17.

LMCs have confirmed that funding has begun to come through to practices, and NHS England reported that £17.2m had been spent on 1,279 practices by the end of March 2017, the BMA report shows.

NHS England also reports spending £10.1m through the vulnerable practices programme, against a commitment of £10m. A total of 22 out of 28 LMCs reported that funding had begun to come through.

However, the BMA also flags up a number of funding initiatives that do not appear to have benefited GPs in all areas equally.

Plans to invest £900m in practice infrastructure, largely through the Estates and Technology Transformation Fund, have seen '653 schemes completed so far, with 225 in the pipeline for 2017-19 and over 800 schemes currently in due diligence', the report says.

Variable funding

However, it warns: 'Although funding has now been secured in many areas the GPC is concerned with the delay in the provision of this funding, leading to slow progress of the delivery of projects in some areas.'

On workforce, the GPC reported 'grave concerns that progress is not sufficient for 2020/21 workforce targets to be achieved', particularly after a recent sharp drop in GP numbers reported by NHS Digital.

The report highlights progress on recruitment and retention through the induction and refresher scheme, and a drive to bring more clinical pharmacists into primary care, but warned that some CCGs had yet to make funding allocated centrally for local commissioners to support training of staff and practice managers.

For the coming years, the report also highlights concerns that some cash-strapped CCGs may be unable to fund plans for greater collaborative working. NHS England announced earlier this year that all practices would be incentivised to move towards working together across populations of up to 50,000 patients.

GPC chair Dr Chaand Nagpaul said: 'The BMA’s GP committee believes that it is vital NHS England is held to account to deliver its promises and funding commitments, and do so in a way that translates into real support for GP practices.

'Our analysis of the first year of the GP Forward View highlights that while there has been some delivery, there have been cases where promised funding has been severely delayed or distributed unevenly across the country. This confusing and inadequate implementation is unacceptable given the huge pressures on general practice from a combination of factors, including rising patient demand, falling resources and staff shortages. Many GP practices are at breaking point and they need certainty that they will get the resources necessary to deliver safe, effective care to their patients.

'We will continue to work with grassroots GPs to provide LMCs and practices with resources to hold NHS managers to account, which has included launching new guidance recently on how to ensure work is not unnecessarily transferred from secondary care. Most importantly, we expect politicians of all parties to put forward positive, well-resourced proposals that will not duck the crisis facing the NHS and general practice in the upcoming general election campaign.'

Arvind Madan, GP and NHS England director of primary care said: 'The GP Forward View is a major, five-year plan to stabilise and strengthen GP services and in its first year alone has seen £500m more invested than in 2015/16, with over £27m of resilience funding supporting 2,000 practices across England. The BMA has a key role to play in helping us deliver further improvements and we will continue working with them for the benefit of GPs and patients in the years to come.'

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