Dr Chaand Nagpaul interview: GPs are winning the battle for new funding

Turning the government's funding pledges into bricks and mortar will define 2015, Dr Chaand Nagpaul tells Neil Roberts.

Chairman of the GPC Dr Chaand Nagpaul is happy to claim his share of the credit for a dawning recognition in government that general practice needs serious attention.

Speaking to GP as 2014 came to a close, he says GPs have begun to win the argument with politicians and NHS leaders that investment in general practice is the only way to avert a crisis in the health service.

Considering the avalanche of negative headlines in 2014 - with MPIG, funding cuts and practice closures rarely out of the news - it is surprising how positive Dr Nagpaul now sounds about the future.

Investment pledge

Perhaps the clearest signal yet that GPs' message is getting through came in December's autumn statement, when chancellor George Osborne pledged a £1bn investment in primary care.

For the GPC, the year ahead will be about ensuring these promises translate 'into bricks and mortar'.

When GP met Dr Nagpaul in December 2013, six months into his tenure as GPC chairman, he had recently secured a contract deal widely praised by the profession.

At the time, he warned that reductions in QOF and DES targets - a marked improvement on the imposed deal a year earlier - were just the beginning. The fundamental question of chronic underfunding still needed to be addressed.

Since then, driving this message home has been central to GPC work. When the 2015/16 contract was announced last September, it was seen as a holding agreement.

Other than tweaks, extensions and retirements of enhanced services and QOF indicators, there was little to shout about - the deal largely maintained the status quo while discussions about funding and infrastructure continued.

Dr Nagpaul is clear that evidence submitted to NHS England chief executive Simon Stevens by the GPC from its 2014 premises survey was key 'ammunition' in the fight for new investment, 'demonstrating the scale to which impoverishment of practices was affecting patients' care'. The GPC took that message to MPs, ministers and NHS England, and was advised new funding would come. This lobbying with evidence was 'instrumental' in beginning to win the argument, says Dr Nagpaul.

Alternative uses

There is a note of caution, however. The GPC chairman admits to being 'highly disappointed' by comments from health secretary Jeremy Hunt suggesting alternative uses for the £1bn pledged for GP premises, from funding co-location of GP services with post offices to funding the shift of specialist care out of hospitals.

Ministers, Dr Nagpaul believes, were conflating the investment pledge with plans for new models of service provision set out in NHS England's Five Year Forward View.

'I have been in dialogue with NHS England,' he says. 'I'm told this money is for infrastructure.' Dates for further discussions are already set.

Empowering practices to control their workload will be a key issue for the GPC in 2015.

Dr Nagpaul is convinced there has been a 'change in political mindset' after an explicit statement in the Five Year Forward View that work transferred from secondary care must come with funding.

He says the GPC helped secure funding that would not otherwise have materialised in many areas, by writing to GPs, calling on them as CCG members to ensure practices receive £5 per patient to support the 'named clinician' enhanced service.

Although Dr Nagpaul believes Mr Stevens is listening to GPC concerns, the current system, which 'on the one hand pays for crude activity in one sector, and on the other expects general practice to absorb work without measuring, quantifying or paying for it', needs an overhaul to ensure work moved out of hospitals is funded.

'CCGs have the power to make sure work shifted out of hospitals is matched by resources,' he adds.

Many of the changes required to shift resources or ease workload are local, Dr Nagpaul argues, and practices must 'stake their claim' as CCG members.

The GPC is developing a programme to help practices manage workload. 'We need to resurrect a sense of empowerment, that practices have the ability to make choices, to manage their workload,' he says.

This could include self-care advice, practices working together, or helping patients who do not need to see a GP to find support elsewhere.

Dr Nagpaul also wants to make better use of patients to 'sell the message for general practice'. Too often, the response to arguments from the BMA is, 'You would say that as a trade union,' says Dr Nagpaul. So this month, the GPC will meet groups of patients to explore their views.

'We need to understand what an elderly housebound person has as their priority. Is it the GP being open at 6pm on a Sunday, or having more care in core hours?' he asks.

A GPC workforce survey early this year will establish priorities for the profession and feed into proposals for future models of care ahead of the general election in May.

This year will be about putting 'flesh on the bones' of promises and proposals from politicians and NHS leaders, Dr Nagpaul says.

'It is clear NHS England and all of the political parties are now speaking the language of general practice being under strain, while at the same time saying the future of the NHS depends on a strong infrastructure for general practice.

'We need to make sure younger doctors can see general practice is going to receive investment.'

* Editorial: Devil is in the detail for GPs in 2015

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