Launching the GP Forward View six months ago, NHS England chief executive Simon Stevens told GPonline that the health service was 'no longer in denial' about the crisis facing general practice.
He hoped that GPs would see the benefits of the support package and extra investment 'sooner rather than later', despite admitting that a decade of underinvestment in general practice could not be fixed overnight.
And despite significant doubts from many GPs, the RCGP hailed the GP Forward View as the most significant deal for general practice since the 1960s.
But six months on from its launch on 21 April this year, GP leaders are warning that support offered to the profession has fallen short of what was pledged, as practice closures continue and practices still face soaring demand and workload pressure.
GP crisis
Londonwide LMCs chief executive Dr Michelle Drage said this week - which also marks two years from the launch of the NHS’ broader Five Year Forward View plans, that the situation facing GPs was bleak.
'At the point the plan aspired to stabilise funding for general practice, the situation is still dire,' she said.
'The Forward View sought to tackle retention and recruitment and introduce stability, but our regular workforce surveys show more GPs are leaving the profession month on month, increased vacancies for GPs and key staff across every part of the capital, and a steady rise in the number of practice closures. It is clear the plan is not working.
'Transformation is not an end of itself – its purpose must be to sustain general practice and our values for patients, which can only go so far without investment. To develop truly collaborative services we need to prime the pump; commissioners must recognise the need for sustainably funding services through periods of transition, and must be realistic about how long it takes to develop new services and bring them into full use.'
A series of major announcements have been made about plans to deliver aspects of the GP Forward View since it was published, even if much of it remains in the pipeline rather than at the frontline. And many elements of support promised so far have been criticised by GPs or met with only cautious welcomes.
Premises
Last week, NHS England set out plans to invest in premises and technology at 300 practices in 2016/17. No details of how much funding they will receive have been published, but the investment is part of a pledge to deliver £900m of capital funding, primarily through the Estates and Technology Transformation Fund.
Nearly 1,000 GP practices have had infrastructure investment since the Five Year Forward View was published, according to NHS England.
However, a BMA poll published in December 2015 warned of many projects facing delays and cancellation. And last week, GPC deputy chairman Dr Richard Vautrey told GPonline that further concerns have emerged: 'While the investment being made in practice premises is long overdue we have been receiving big concerns about the funding from practices who have been surprised that despite the promise in the GP Forward View that they would receive 100% reimbursement that they are now expected to pay one third of the cost themselves, and in some cases CCGs have told practices that they will not pay the increased rental reimbursement due as practices increase in size.
'This double whammy will mean some practices will not be able to progress with much needed schemes and will be left to limit their list size instead. This is exactly the opposite of what the GP Forward View promised.'
An NHS England spokeswoman told GPonline: 'Regardless of the percentage contribution, no GP practice will be left out of pocket. They are, and will continue to be reimbursed by NHS England for their ongoing rent or mortgage costs as set out in the premises costs directions so that where there is a part contribution, this will be taken into account as part of these reimbursements.
'Under the current directions the ability to fund is between 33-66% as the norm. A project can be supported to a lesser or greater extent and the GP Forward View has committed to changes that will mean 100% funding is possible. However, in all cases, the level of investment will depend on the specific aspects of each project and the impact of any ongoing revenue that is required. All projects will be reviewed to ensure that the investment is good value for money. 100% funding may be possible where it provides value for money.'
Resilience Fund
NHS England was due to decide last week which practices would become the first to benefit from the Practice Resilience Fund, which promised to deliver £40m over four years to support struggling GP practices. Officials are likely to reveal in November which practices will receive a share of the £16m available in 2016/17.
According to NHS England, 'the full £16m must be spent' by 31 March 2017 and local teams have been asked 'to confirm spend or evidence commitment of funds to practices by end of December'.
NHS England announced in tandem with its update on infrastructure investment that it would invest £5m this year in a repeat of last year's winter indemnity scheme, offering financial support for GPs who take on additional out-of-hours shifts.
Officials also pledged earlier this year to invest £60m over two years to help practices cover the cost of GP indemnity, to be paid out to practices based on their list size.
Dr Vautrey said the extension of the winter indemnity deal was welcome. 'The indemnity scheme is important and something GPC has been lobbying for through our Urgent Prescription for General Practice. We need though to continue to look for longer-term solutions to the indemnity crisis.'
GP health service
NHS leaders also launched the 'world's first free health service for GPs' earlier this year - a service intended to help GPs struggling to cope with soaring pressure. The £19.5m service will boost 'access to mental health support for general practitioners and trainee GPs', offering confidential support for any GP or trainee suffering mental ill health issues including stress or burnout.
Dr Vautrey warned that the service must not risk overloading existing mental health services: 'Greater support for patients with mental health problems is to be welcomed but care needs to be taken that this expansion is not at the expense of the currently seriously overstretched community mental health services. With a shortage of therapists there's a risk the new service is developed by poaching existing staff.'
In September, NHS England unveiled plans to give every CCG £6 per patient to fund extended GP access from 2019, with many areas already piloting extended access due to receive additional funding earlier.
Meanwhile, details of mutispecialty community provider (MCP) contracts are due to be published soon, which will include how funding will work for practices. Part of the MCP proposal involves letting practices drop the QOF but retain their GMS contracts.
Sustainability and transformation plans (STPs) have also been submitted by the 44 'footprint' areas across England, and will begin to be implemented from autumn 2016. The implications of the plans are likely to be significant for GPs and could define how support is delivered in many areas.
Podcast: What do STPs mean for GPs?
But GPs remain concerned that despite all this, not enough is being done to tackle the ongoing GP crisis - with the BMA warning that practice closures are at record levels.
Dr Drage warned: 'Our general practices are the backbone of the NHS - providing for 90% of patients' needs on a paltry 8% of its budget - and falling.
'The NHS Five Year Forward View provided a vision of transferring investment from acute trusts to primary care, more GP training posts, better premises and above all "stabilising core funding for general practice nationally over the next two years".'
GPs need 'more resource and more support to secure the future of the profession, she warned. 'And we need it now, before it is too late.'
