GPs slam STP proposal to shift 'massive amounts' of work into general practice

GP leaders have slammed plans to transfer 'massive amounts' of secondary care work into general practice without proper support to resolve the 'catastrophic crisis' facing the profession.

Birmingham LMC secretary Dr Robert Morley
Birmingham LMC secretary Dr Robert Morley

LMC leaders in Birmingham have accused local NHS bosses of planning ‘far reaching changes’ to general practice in the city without properly consulting GP provider representatives.

A document obtained by Birmingham LMC revealed draft plans for general practice in the city being developed as part of the sustainability and transformation plan (STP) for Birmingham and Solihull.

The proposals include new seven-day primary care hubs that would serve populations of 40,000 to 100,000 and provide specialist outpatient appointments; virtual beds supporting patients discharged earlier from hospital, primary care appointments available within 24 hours and seven-day GP appointments.

The STP proposals revealed that local NHS leaders expect to resolve financial problems by shifting activity out of hospital.

Birmingham LMC secretary Dr Robert Morley, who also chairs the GPC contracts subcommittee, told local GPs the STP was ‘proposing fundamental and far reaching changes in the way general practice is delivered’.

‘There has been no consultation with the LMC, nor to my knowledge with any representatives of GPs or practices as providers,' he said.

But STP leaders said GPs from CCGs, provider organisations and LMCs were involved and that there would be extensive consultation with practices on the draft plans.

GPonline reported in May that GPs in some areas felt they were being ‘ignored’ by STP organisations.

In a letter sent to GPs in Birmignham this week Dr Morley wrote: ‘It would appear that plans by the STP to transform general practice, and transfer massive amounts of secondary care work into general practice, are already very far advanced indeed, and only at this late stage have been shared with GP provider representatives.’

The STP proposals would mean ‘radical transformation without fully recognising or paying due regard to the need to properly support general practice in order that practices remain viable and sustainable', said Dr Morley.

There was, he added, no detail about any additional recurrent funding for core GP services.

Read more: What is an STP?

STPs are being developed by 44 local ‘footprint’ collaborations of health and care providers and commissioners to plan how local services will be made sustainable over the next five years and how to implement the vision of integration in the Five Year Forward View.

The plans, which were due to be submitted in their first stage to NHS England in June, will become the basis for all new transformation funding for the NHS, including much of the new funding promised in the GP Forward View.

NHS England chief executive Simon Stevens has said he expects STPs to deliver a shift in care and resources into primary care and community services.

The document obtained by Birmingham LMC outlined plans for the Birmingham and Solihull (BSol) STP enhanced general medical workstream, involving Birmingham Cross City, Birmingham South Central and Solihull CCGs, Birmingham and Solihull councils and seven local NHS provider trusts.

The document reveals plan to commission GPs to provide prevention services supporting long-term conditions and mental health ‘above GMS contracted services’ for all ages registered and unregistered population.

GPs could, under the plans, work at ‘place-based’ level, serving populations of 40,000 to 70,000 and in integrated service hubs with populations of 100,000 to 300,000.

The plans will be developed into multispecialty community providers and primary and acute systems models and ‘ultimately’ into accountable care organisations.

The plans are expected to achieve a reduction in variation in services, sustainability and seven day access to general practice.

The transformation is also expected to ‘contribute towards the STP’s financial gap through shifting appropriate activity from the acute setting to the community’, the document said.

Support for general practice

Dr Morley told GPonline that there was ‘no doubt’ the main thrust of all STPs would be to ‘resolve hospital deficits and hit their political targets whilst the NHS remains grossly underfunded’.

‘To do that they will aim to shift massive amounts of work out of hospital. The theory is fine, but the practice will be in the context of the massive underfunding and the unprecedented catastrophic crisis in general practice,' he said.

‘Any shift of care out of hospitals needs to be accompanied not just by the required shift of funding, staff and all other required resources and support into general practice and wider primary care, but also the additional funding needed to ensure that core general practice gets what it needs both to ensure the sustainability and viability of GP-led general practice and the delivery of safe essential GP services.

‘Sadly the extent and depth of the crisis in general practice, and the degree of action required to resolve it, remains grossly underestimated. Any grand plans for radical transformation remain pie in the sky unless they are accompanied by the will and the resources to ensure general practice sustainability.’

Clinical head of commissioning at NHS Birmingham South Central CCG and work stream co-chairman Dr Richard Mendelsohn said: ‘The enhanced general medical practice work stream is an integral part of the STP for Birmingham and Solihull. For the work stream to be successful, representation from general practice needs to be at the heart of it.

‘The work stream is co-chaired by three local GPs, and includes representative members from each CCG, the Birmingham LMC and the independent GP Alliance, which has recently come together in Birmingham and Solihull. The GP Alliance is also represented at the three key layers of governance within the STP – programme board, system board and leaders and chairs board.

‘At this stage the plan is a draft, and extensive engagement with the membership of the three CCGs is planned throughout September before the final document is submitted for approval.’

Photo: JH Lancy

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