General practice has been in a parlous state for several years. Just this week GPonline reported that real terms spending on general practice had fallen £250m since the Conservative-Liberal Democrat coalition took power in 2010. It's long been clear to GPs that something had to be done to address the crisis.
Today we find out what that something is. General Practice Forward View is NHS England's ‘support package’ for the profession and its attempt to address many of the problems that have besieged GPs in recent years.
The headline figure of a £2.4bn a year increase in funding for general practice, which will take its share of the NHS budget to 10%, makes for impressive reading. This is just shy of the 11% share of the budget that the RCGP has long been campaigning for. So, does this mean that general practice is saved?
Firstly we need to be clear that this money is not being pumped into core funding for practices. It is all attached to schemes and initiatives NHS England is keen to push and develop. Some of these will potentially benefit all practices, others will only help those practices embracing the government’s plan to deliver general practice ‘at scale’.
Secondly, this is not new money from the Treasury, it is money from the overall uplift in funding for the NHS that was announced in the Autumn statement. It means other areas of the health service will be receiving proportionally less.
And, thirdly, bringing general practice funding up to 10% of the NHS budget is simply taking it back up to the proportion it received a decade ago – and where it should have been all along.
However, the plan does mean that NHS England is no longer in denial about the problems GPs face and is making efforts to address some of these (see NHS England chief executive Simon Steven’s exclusive interview today with GPonline).
There are plans for how NHS England will meet the government target of recruiting 5,000 more GPs by 2020. This includes increasing training places, a major international recruitment campaign, bursaries for areas that have found it hardest to recruit and plans to simplify return to work processes.
As important is a commitment of £19.5m (£16m of which is new funding) for a new national service to provide GPs with free access to mental health and support, which will be available from December 2016. This is long overdue and will hopefully help to address soaring levels of stress and burnout in the profession.
Practices will also welcome funding for training and development of staff – £6m for training practice managers and £45m for reception and clerical staff (according to the document every practice will benefit from the latter). An extra £15m for practice nurse development, including return to work schemes, is also a positive step and could go some way to head off an impending crisis in this profession.
A commitment to expanding the general practice workforce by recruiting 3,000 mental health workers and a further 1,500 clinical pharmacists to work in practices could also potentially alleviate some of the pressure on GPs.
Many GPs will be disappointed that NHS England has effectively ruled out extending crown indemnity to GPs, but it has pledged to set out proposals in July to reduce the soaring indemnity costs faced by the profession. Watch this space.
Addressing GP workload
The section of the Forward View relating to workload makes interesting reading, but I suspect many GPs will question whether these plans go far enough.
Changes to hospital contracts should stop patients being bounced back to GPs if they fail to attend an outpatient appointment or require onward referral.
Practices rated good or outstanding by the CQC will only be inspected every five years, which is potentially an improvement on the current situation but a long way from LMCs’ call to scrap CQC inspection altogether. On the plus side, NHS England has said it will cover the costs of any increase to CQC fees.
In addition to the £10m NHS England had previously pledged to support vulnerable practices, a further £40m will be used to develop a practice resilience programme, but there are no details on how this will work and whether vulnerable practices will benefit from any actual additional funding.
However, practice managers will be delighted to hear that NHS England plans to simplify the GP payment system. And, interestingly, NHS England says it will make available an automated appointment-measuring system to every practice in 2017/18 that will help practices match supply of appointments to demand.
Access it one of the biggest day-to-day issues practices face – and one of the main sources of patient complaints - so this could go some way to helping deal with this.
There are potentially big changes ahead for premises. From September 2016, NHS England will fund up to 100% of the costs of premises development rather than the previous cap of 66% - it will be interesting to see whether this means more practices are able (or prepared) to embark on premises development projects. The Forward View also suggests that ‘at scale’ projects will receive 'support' so they can move quickly through the design, financial and legal processes.
IT will also receive a boost and a £45m programme will aim to support the uptake of online consultation systems. Among other things, CCG IT funding will aim to improve digital access to patient records for clinicians and, in 2017/18, fund WiFi for staff and patients within practices.
Implementation will be key
So NHS England is taking positive steps, but it remains to be seen how accessible the additional funding will really be to practices given that none of it is going into core pay.
Accessing some of this money will no doubt require funding bids and requests, some of it will depend on how CCGs decide to allocate the funds they receive and other streams of money will only be available by signing up to the new MCP contract - and detail on how this will work is scant.
While there are things to welcome in the new package, it's the detail and implementation that will matter. How all of these new initiatives are rolled out and how quickly the impact of this increased spending reaches the frontline and makes a genuine difference to GPs' daily working lives will be the real test of whether the Forward View can rescue general practice.