The London Assembly’s health committee heard evidence on GP services from Londonwide LMCs’ chief executive Dr Michelle Drage and chairwoman of NHS England London’s transforming primary care board, Professor Clare Gerada.
Professor Gerada told assembly members general practice in the capital was failing.
‘It’s not only failing to deliver care to its patients, but it’s failing itself,’ she said. ‘We’re failing not because we don’t want to succeed, but actually.. we don’t have the resources. And we have one of the most demoralised workforces I’ve ever...witnessed. We are battered from all sides.’
Dr Drage told the committee it should shift its attention away from how general practice can solve problems in hospitals and A&E. ‘Nobody looks at where you enter the system,' she said. ‘The whole of the political focus and funding focus is right down the end of the line, where you've been referred.’
Reduced and fragmented community services meant GPs had nowhere to refer patients, said the LMCs leader. She warned that a new approach was needed to commissioning and funding to support general practice, rather than ‘grand designs’ to reorganise services.
‘We need to go back to basics. We need to look at the stock of premises, we need to look at the the way services are commissioned to support GP delivery. Hospitals get paid for every time a patient walks through the door. It’s called payment by results. Anyone can call a result an attendance; and they play games with our money. And the commissioners through the CCGs haven’t been empowered to deal with that. They’ve solely been focused on the hospitals’ spend.’
Dr Drage warned that remedies in the new contract agreement that will ease the burden of QOF would be ‘dwarfed’ by the problems of MPIG cuts.
‘The protection…is being reduced and we have massive hits about to happen which will dwarf anything that goes on in terms of the QOF imbalance.
‘So if you think things are bad now,' she warned assembly members, ‘they are about to get worse over the next five years. That’s why we need solutions. But it’s about solutions for patients on the ground, not grand strategies. It’s about what gets delivered on the ground for patients.’
Professor Gerada called for a ‘redesign’ to shift funding from hospitals into general practice.
‘General practice is haemorrhaging,' she told the committee. ‘It’s heamorrhaging staff, it’s heamorrhaging in its buildings. You come to my practice: we hot desk. We cannot stay beyond our hours because we have to have someone sitting in that desk.’
‘It has to be a redesign. There has to be a focus now on releasing money from secondary care; real money, and real people, into primary and community care.
‘If we don’t, I’m really serious about this, we won’t have an NHS that can deliver the kind of outcomes we do now.’
- See the 17 February issue of GP magazine for an exclusive interview with Dr Drage on Londonwide LMCs’ latest plans for general practice in the capital