GP transformation money must not be tied to extended access, warns GPC

Transformation funding for general practice promised in the GP Forward View must not be rigidly tied to extending access, GP leaders have warned.

GPC deputy chair Dr Richard Vautrey
GPC deputy chair Dr Richard Vautrey

The GPC has said that practices in parts of England are concerned that CCG funding promised in the GP Forward View to support transformation was being tied to extending access.

Deputy chair Dr Richard Vautrey called on commissioners to use the money ‘more creatively’ to support practices to work collaboratively.

The warning comes after NHS England last week announced plans to incentivise every practice in the country to work together in 'local care networks' serving 30,000 to 50,000 patients. The Next Steps on the Five Year Forward View report revealed there would be national funding incentives to encourage practices to join.

The GP Forward View, published in April 2016, promised to increase overall GP funding by £2.4bn a year by 2020/21. The plan promised £171m over two years would be made available for ‘practice transformational support’ through CCGs.

Sustainable general practice

Commissioners were told to spend £3 per head from their core allocations as a non-recurrent investment over two years from 2017/18. The funding is meant to stimulate development in at-scale providers for improved access, stimulate implementation of the 10 high impact actions to free GP time, and secure sustainability of general practice.

But Dr Vautrey said there were some areas of the country where the GPC had been made aware of ‘concerns from practices’ that the funding was ‘tied very rigidly to delivering extended access’.

‘I think it needs to be used more creatively to support practices that want to work in co-operation without necessarily developing formal multispecialty community provider (MCP)-type structures.’

A separate fund administered by CCGs is earmarked by the GP Forward view to support the further roll-out of extended access schemes. Existing sites set up through the GP Access Fund will receive £6 a head from NHS England via CCGs for the next two years, with all remaining areas receiving £3.34 per head in 2018/19, and from 2019/20 every area will recieve £6 per head recurrent funding.

Dr Vautrey welcomed NHS England’s recognition in the Next Steps announcement that there was no one model for working at scale but warned that must be recognised by local commissioners. ‘The idea everyone has to be in an MCP is clearly not being promoted by NHS England,' he said. ‘I think it is important that message gets down to middle managers in NHS England and CCGs so they don't feel they have to pursue an MCP agenda as the only way of supporting practices to work at scale.’

GP collaboration

Dr Vautrey said practices should have the opportunity, as set out in the Next Steps report, to pursue collaboration with funding support, although there is no detail yet on what funding will be available. He warned that non-recurrent funding, such as the £3 per head from CCGs, would not sustain the new structure required for working at scale.

He called for more funding to be moved from CCGs to providers as the local commissioning groups’ role is diminished with the increasing focus on providers. ‘ As they start to reduce their activity and hand over some of their provider role to provider groups they have to transfer some of that resource that is supporting the current management activity into provider groups so that they can make themselves sustainable in the future.’

Last week National Association of Primary Care (NAPC) chair Dr Nav Chana told GPonline that new funding was not necessary for developing at-scale provision. Launching the first impact analysis of the primary care home model of integrated provision for 30,000 to 50,000 patients, Dr Chana said that while new money to support collaboration development would be ‘brilliant’, it can happen without extra funds.

The NAPC’s initial 15 of its 92 primary care home pilots were given around £1 patient from NHS England and the NAPC, but subsequent projects had nothing centrally. ‘What is important is not necessarily, pump a load of money in and something will happen,’ Dr Chana said. ‘That would be great. It's more about the will, the energy, the values, the commitment to doing things differently, which is driving some of this.’

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