Many STPs 'fail to address GP crisis' and must be rejected, says RCGP

A significant number of sustainability and transformation plans (STPs) should be rejected for failing to address general practice sustainability and workforce issues, the RCGP has said.

Professor Helen Stokes-Lampard (Photo: Pete Hill)
Professor Helen Stokes-Lampard (Photo: Pete Hill)

The college made the recommendation in a damning report which analysed all 44 draft transformation plans and progress on implementation of NHS England's GP Forward View.

STPs, drawn up by local NHS organisations and councils, were in some areas planning for a reduction in GP numbers or zero growth in the workforce, the college found. General practice was being treated as a solution to problems in secondary care by some STPs, according to the report.

Many STPs failed to show how the GP Forward View - which pledged to increase annual GP funding by £2.4bn a year by 2020/21 - would be implemented locally, the report found.

GP practice closures

Meanwhile, the college criticised progress on delivering the practice resilience element of the Forward View, which promised extra resources to help vulnerable and struggling practices. Progress on the scheme was ‘extremely disappointing’ while significant numbers of practices remain at risk of closure, it said.

RCGP chair Professor Helen Stokes-Lampard said while there had been some positive progress on implementing the Forward View package of support announced last April, there remained a ‘huge amount’ to do at local level to ensure GPs notice improvements.

‘It’s incredibly frustrating to hear that pots of money are just sitting there waiting to be spent – money that has been earmarked for struggling practices. NHS England needs to be out there, making sure the practices who could benefit from this money know about it, and making it easy for them to access it,' she said.

The report found that by the end of 2016 just £2.5m of the £16m practice resilience fund had been spent and the full amount was unlikely to be spent by the end of the financial year. NHS England has said that it aims to spend the funding for practices by the end of the 2016/17 financial year. While over 1,000 practices have been identified to receive support, the college said just 219 have so far recieved any.

Government procurement rules had been a barrier to NHS England local area teams quickly commissioning support on the ground, the report said. 

GP funding

An earlier 'vulnerable practice fund' worth £10m - announced in 2015 - has so far only seen £6m invested, the report added. NHS England has again said the full amount will be spent by the end of the financial year. Its director of primary care, GP Dr Arvind Madan, has previously acknowledged NHS England had been too slow to allocate the funding.

The college report said NHS England had confirmed it was on track to spend a promised £322m on primary medical care this year, but warned of the risk of CCGs underspending on their commitments. It also criticised progress on reforms to indemnity arrangements, despite welcome short-term funding to offset cost rises.

The report also noted that NHS England has said plans to replace the QOF would not be concluded this year.

Significant numbers of STPs, the RCGP said, were failing to meet NHS England’s requirement to ‘develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues’.

Some STPs failed even to mention the GP Forward View, despite being directed by NHS England to address it, while others gave little or no detail as to how it would be implemented.

GP workforce

STPs were being driven largely by the requirement to reduce hospital trust deficits, which was ‘likely to affect the level of investment available for general practice’. While general practice was frequently viewed by STPs as ‘a solution to problems in secondary care, without sufficient efforts made to stabilise and support it’.

Workforce plans were ‘not sufficiently robust’, the report added, while some STPs ‘foresee a decrease or stagnation in GP numbers’, as first reported by GPonline last year.

Where additional investment in general practice is identified in STPs, it is almost always intended to deliver new services rather than support existing practices, the RCGP report found. Investment is also normally intended to deliver savings.

Professor Stokes-Lampard said the lack of recognition for general practice in STPs was ‘extremely concerning’. She warned: ‘This is against all common sense, against all the evidence about how to run an efficient health service and against NHS England’s own guidance.'

Ring-fenced funding for general practice infrastructure was ‘very limited’ in STPs, while local demand for extended access was rarely assessed, the report said, and STP plans for new models of care too often portray shifting care out of hospital ‘as a solution, without significant engagement with the effect this will have on workloads’.

The college also criticised the level of involvement of GPs in STPs which it said were ‘top down’ and lacked transparency.

The report called for the government and NHS to ensure GP Forward View pledges are met and delays are tackled. STP leaders, it said, should ensure the plans are implemented, with proposals to expand the GP workforce and engage with GPs. CCGs, it said, should set out plans for investment in general practice and should be held accountable by NHS England for delivery of the Forward View.

Professor Stokes-Lampard said: ‘The overriding message to government and decision makers is to prioritise general practice as they push forward in shaping the NHS for the future of patient care. We are seeing progress at a national level – we need to see it at local level, we need to see it having a positive impact on the front line of patient care in the community, and we need to see it benefiting our patients.’

NHS England director of primary care Dr Arvind Madan said: 'This report rightly acknowledges the significant progress made in delivering support for general practice, including the £30m General Practice Development Programme, the launch of a GP Health Service and a return-to-practice scheme that has already attracted 200 doctors since November. We are only nine months in to a five-year action plan and we are working hard to deliver the further measures that will strengthen general practice and support GPs long into the future.'

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