Dr Mark Spencer, who leads the wave-two prime minister’s GP Access Fund (formerly the Challenge Fund) pilot in Fleetwood, Lancashire, told GPonline the government and NHS England should contract the pilots to provide security for their services and allow them to employ staff rather than having to rely on sessional staff.
Health ministers and NHS England leaders are expected to announce the next stage in the roll-out of seven-day services early next month as part of a package of primary care policies.
DH has mandated NHS England to provide seven-day routine appointments for a fifth of patients by 2017 and all patients by the end of this parliament.
|What is the GP Access Fund?|
The first 20 wave one Access Fund pilots were launched in 2014 with £50m of funding. A second wave of 37 pilots was announced in 2015 with £100m. The government also pledged to spend an additional £400m to ensure every patient in England has evening and weekend access by 2020.
An announcement expected in early February is expected to include details of the roll-out of new care models and the enhanced GP services developed by the prime minister’s GP Access Fund pilots.
The policy package is expected to include details of investment, but GP leaders have questioned where the resources will come from and warned against raiding a £1bn fund initially allocated for GP premises.
Health secretary Jeremy Hunt told MPs in early January the government was ‘looking at how to maintain funding’ for those areas where Access Fund pilots have been established.
Seven-day general practice
Dr Spencer, who took up the position of NHS Alliance co-chair following the retirement of Dr Michael Dixon, said the expected policy announcement should seek to secure the seven-day pilots, but warned that new, long-term, recurrent investment was required to achieve the government’s ambitions.
The government and NHS England should ensure the future longevity of the programmes, he said. ‘It would be something like: here is a contract to deliver what you have been delivering for the next five years.
‘That then allows federations or other organisations to start to recruit. Because trying to deliver a service on a one-year contract you're not going to get people to come and work directly for you. We are only able to attract people to work on a sessional basis and that is not a stable long-term solution. So, give providers the sorts of contracts that allow them then to recruit staff.’
Dr Spencer called also for an assessment of the success of the access pilots in terms of health outcomes rather than how convenient appointments are for patients.
‘All we have been judged on so far is activity: how many patients can you get through the door on a Saturday and Sunday,’ said Dr Spencer.
‘That's fine to show we can do it. But in the long term, let's have some real outcome measures that show how effective seven-day working is as opposed to just creating more appointments for patients to book more easily or conveniently. Actually, is it improving the health of the community?’
Dr Spencer, whose Fleetwood evening and weekend pilot was set up by four practices with a £500,000 award from the Access Fund in March 2015 to serve 30,000 patients, said he supports the government and NHS England’s aim of extending access, but wanted to see long-term resources and stability.
The NHS Alliance co-chairman said he feared that a recent funding uplift for general practice of 4-5% a year for five years would be allocated only for the provision of new services rather than plugging existing funding gaps.
‘I support the movement of care into the community,’ said Dr Spencer. ‘My worry is that the additional funding that's been announced, is very welcome, but my worry is that that is purely for new services. And providers are going to be asked to take on new services to attract that funding.
‘I think there is a current funding gap and we need to adequately resource current provision before we start talking about taking on new care.
‘Until we stabilise primary care we are not going to be in a position to take on all the new models we are keen to take on.’
A supporter of the practice federation model of general practice, Dr Spencer warned small practices may become unviable under the emerging commissioning and contracting landscape and shift of care out of hospitals as provision at-scale becomes necessary.
‘As services move into the community a small practice isn't going to have the range of clinicians to deliver the sort of care that complex patients in particular need,’ he said.
Dr Spencer said he wasn’t a big supporter of 'mega practices’ or corporate providers, but that federations allowed practices to provide the ‘best of both worlds’ in terms of intimacy and continuity for patients as well as collaboration and scale.
Small practices, he added, would ‘struggle to deliver the range of services that will attract the income. So they may fold on a financial basis.’
|Who are the NHS Alliance?|
The NHS Alliance, founded in 1998 from the GP clinical commissioning movement, has indicated a change in focus under a new multidisciplinary leadership team. The organisation will seek to better represent primary in the widest sense, focusing on the wider determinants of health. The Alliance, said Dr Spencer, will encompass housing, education, public health, health inequalities policy as well as general practice and other areas of primary care.
The organisation wants to support the aims of moving more care out of hospitals but recognises the pressure that can put on general practice and that GPs will not be the sole solution to that shift, he said.
Dr Spencer said NHS England’s new care models being developed were a step in the right direction towards better at-scale integration and collaboration, so long as there was adequate resourcing.