Exclusive: NHS 'no longer in denial' over GP crisis, says Simon Stevens

The health service nationally has been 'in denial' about the crisis in general practice, NHS England chief executive Simon Stevens admitted as he unveiled the GP Forward View, a plan to boost GP funding £2.4bn a year by 2020/21.

Speaking to GPonline as NHS England launched the landmark General Practice Forward View package of support for GPs, Mr Stevens said there had been a ‘sea change’ over the past year in the health service from ‘denial to acknowledgement’ of the effects of underinvestment in general practice.

‘What we are saying today is we have to convert acknowledgement into action,' he said as NHS England launched its plan to increase annual GP funding to more than £12bn a year by 2020/21 from the 2015/16 level of around £9.6bn.

Mr Stevens said he hoped GPs would see the benefits of the rescue plan ‘sooner rather than later’. NHS England had ‘listened hard’ to practical suggestions from GPs, LMCs, the GPC and RCGP, the NHS chief said.

GP crisis

‘Everybody has told us that the big things that need attention are funding, and workforce, and cutting red tape and unnecessary workload, and investing in infrastructure, and redesigning the interactions between GPs, hospitals, community services and other bits of the public service,' Mr Stevens said.

‘On each of those five big building blocks I think we have got a very practical set of things there is a consensus need to be done.’

'To that extent I hope GPs will experience the benefits sooner rather than later. Not that there is a magic wand, and not that all the pressures that have built up over a decade of relative under-investment can be sorted out over night. Of course they can't. But I hope that people will see we are on their side and we are going hell for leather to make things better.'

NHS England's director of primary care, GP Dr Arvind Madan, added: 'We will be working as fast as we can to get as much as we can done as soon as we can, working with the GPC [and] RCGP.'

On the new funding announced, Mr Stevens told GPonline that a ‘disproportionate’ share of national NHS England funding 'buckets' announced following the government spending review settlement - announced in November 2015 - would be diverted to general practice.

These tranches of funding include the national transformation fund, an allocation for IT, and funds for transforming mental health services.

GP investment

‘We have taken a hard look at what we should be earmarking, of other parts of the NHS funding growth over the next five years, and specifically deploying that into general practice,’ he said.

‘On each of the big buckets, what was previously a holding sum nationally, we've said this is what’s going disproportionately in favour of general practice, that’s what it would mean for each of those items. And together that's what gets you the £12bn plus the £500m immediate rescue package.’

Mr Stevens said that while the new funding would be attached to specific programmes rather than delivered into core practice funding, GPs would feel the benefit of it.

‘It will all, in combination, be something that GPs themselves will be able to notice,’ he said.

‘If you are funding extra staff in general practice, if you're funding extra practice resilience schemes, if you're funding support for stress and burnout, you might not route that through the global sum, but nevertheless if there is help service available for GPs under the situation, that is a direct benefit.’

Enhanced access

Mr Stevens said an additional £500m by 2020 funding for CCGs to commission and fund additional capacity including evening and weekend appointments and out-of-hours and urgent care services, was recognition of the need for additional resources to support the expansion of enhanced access services.

‘We know the vast amount of patient consultations occur in the in-hours period, and so you can't think about overall GP workload or patient satisfaction without addressing that,' he said.

'As well as questions about enhanced access. And so, you have to sync up the workforce expansion of GPs and other primary care clinical professionals with redesign of local GP hubs, federations, the out-of-hours services, urgent care centres - all work together, and if you do that, then there is absolutely no reason why this should be imposing higher burdens on individual GPs. But, it can't be done overnight.’

While the government has previously indicated that extended access services rolled out from the GP access/challenge fund would not require additional central funding, Mr Stevens said: ‘What we have done is take a realistic look at what will be required in order to be able to resource the expansion in GPs and other disciplines we want in primary care and back that with money.’

He added: ‘We are suggesting there will need to be an expanded workforce and matched funding. But we are also saying that we think it will produce downstream benefits for the rest of the health service.

‘There is no great surprise that if you underinvest in primary care, pressures show up in other parts of the system. And it is unreasonable to ask GPs to take on more when they've not got the resource and backing to do it.

‘But you've got 300m-plus GP consultations a year and 20m A&E attendances, you only need very small changes in the availability of GP services for that to show up in other parts of the system. But if you've expanded funding for hospitals faster than you've expanded funding for GPs, QED.’

GP Forward View: Full coverage

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