Proposals seen by some LMCs would require practices to sign up to savings or outcomes measures to offset the funding commissioners have been told to spend.
The GP Forward View, published in April 2016, pledged £171m non-recurrent transformational support to help practices work at scale, implement the 10 high impact actions for reducing workload, and to secure sustainability. CCGs were directed to fund the package at £3 per head across two years, from their existing baselines.
The GPC has warned previously that some CCGs were attempting to ‘rigidly’ tie GP Forward View transformation funding to extended access requirements. It now believes that despite the two-year programme beginning in April, only around half of CCGs may have agreed effective plans to date.
In some areas, local commissioners struggling with deficits are understood to have told practices that the transformation funding plans must be ‘cost neutral’. CCGs have said the funding could be dependent on practices meeting outcomes or savings requirements.
The GPC’s GP Forward View policy lead Dr Chandra Kanneganti told GPonline following a meeting of LMC representatives last week, that while there were many good plans, some CCGs were failing to implement the scheme properly. Around half of CCGs have so far come up with good implementation proosals, the GPC estimates. Others, said Dr Kanneganti, had either failed to draw up plans, or had developed plans which would negate the requirement for additional funding going to practices.
‘Unfortunately, we have been getting information that some areas are saying: "We will invest that, but it must be cost neutral, we need to have some outcomes and savings from that",' said Dr Kanneganti. ‘That should not be. This should be invested on the basis that practices can work at scale, try new things, new innovations to work at scale, try towards locality care hubs and new models of care.’
Dr Kanneganti said there were examples of good plans, such in his own area of Stoke, where the CCG had agreed a £1 per head local enhanced service to fund practices to develop systems for working at scale and £1.50 per head for the federation to support work on the 10 high impact actions. ‘There are some good actions happening,' said Dr Kanneganti. ‘But in some areas, unfortunately, CCGs feel that they don't have that kind of money.’
Primary care investment
He added: ‘Those CCGs who are in deficit are trying different things. But we are opposing that, saying - the reason why you are in deficit is because you're not investing in the right place. Now, try to start investing in primary care, where you get better outcomes and try to invest in practices working at scale and you'll get better outcomes in future.’
Last month NHS England announced that it would incentivise every practice in England to work together in ‘primary care networks' serving 30,000 to 50,000 patients. The Next Steps on the Five Year Forward View report announced there would be national funding to support the plan including for extra staff and premises investments, although further funding detail is yet to be revealed.
Dr Kanneganti said that a meeting of LMC representatives held in London last week heard about a number of examples of good schemes set up to implement the 10 high impact actions and other elements of the GP Forward View.
Progress had been variable across the country, he said, but LMCs and practices should take the initiative to develop plans and proposals to take to CCGs to secure the promised funding. The difference, he added, between areas where implementation was fast, and areas where it was slow, was that ‘where it's working well is where LMCs have close relationships with CCGs and NHS England and they work as a group’.