At a time of severe GP shortages, when we know that one in three GPs surveyed intend to retire in the next five years, it is vital that every effort should be made to retain the trained GP workforce.
I am therefore pleased that the GP Retention Scheme has now been launched, which GPC has helped negotiate on your behalf through the 2017/18 GMS contract negotiations, as well as it being a commitment in the GP Forward View.
In essence, the GP Retention Scheme (formerly the Retained Doctor Scheme) is a package of support and resources aimed at GPs who may be considering leaving the profession, to remain in clinical practice providing between one and four sessions per week. It includes protected time for continuing professional development with educational support.
The scheme supports both the GP who is being retained and the practice employing them by offering financial support in recognition of the fact that this role is different to a ‘regular’ part-time, salaried GP post, offering greater flexibility and support. Retained GPs may be on the scheme for a maximum of five years with an annual review each year to ensure that the GP concerned remains in need of the scheme and that the practice is meeting its obligations.
Practices will be resourced to pay the retained GP an annual professional expenses supplement of ￡1,000 per weekly contracted session to help fund the cost of indemnity cover, professional expenses and CPD needs. The practice will also receive ￡76.92 per session towards the employment costs of the retained GP, up to a maximum of ￡15,999.36 per annum.
The most valuable resource available to the NHS is its workforce. That is why GPC supports anything that can be done to ensure skilled, experienced and hard-working GPs are able to remain within the profession and that they are provided with opportunities to continue to develop their careers and contribute to the provision of patient services.
Again, please read our step-by-step guidance for more information.
NHS Digital figures show decrease in full-time GPs
The launch of the updated retention scheme comes in light of the release of the latest figures from NHS Digital that show a decrease in the number of full-time GPs in general practice, and no increase in overall GP numbers in England.
These figures underline, despite constant promises from ministers that the GP workforce would be increased by 5,000, just how far we are from meeting the Government’s own target. While there have been encouraging increases in other healthcare professionals in general practice, what we really need are GPs who can deliver more appointments and other frontline services to meet rising patienhalf of the t demand.
These figures could be compounded by the triggering of Article 50, creating uncertainty about the future status of doctors and other healthcare professionals from the EU. With almost half of the 10,000 EEA doctors working in the NHS considering leaving the UK because of the referendum result, this could further reduce the number of GPs delivering care in the NHS.
It is time for the Government to act urgently to safeguard the current GP workforce, while implementing measures including those in the GP Forward View to enable a safe, manageable and rewarding workload – which is what we need to reverse the current decline in GP numbers.
Monitoring the GP Forward View
I recently attended the GP Forward View Advisory Group, which oversees NHS England’s implementation of the GPFV. GPC is clear that NHS England must be held to account to ensure spend and delivery of its commitments to support general practice in a meaningful and timely way.
GPC also monitors GPFV through regular structured feedback from LMCs. We have an LMC reference group, which met last week, in which representatives of LMC regions across England come face to face with senior managers at NHS England. What these various sources of information have revealed is the striking disparity between local area teams and CCGs – such as areas where resilience funding has been spent and provided much-needed support to practices, from management support to clinician backfill, organisational development and helping practices to work together.
Yet in other localities, practices under the greatest of pressure had yet to be notified of any resources while struggling to survive. I have formally written to NHS England – and am following this up at the highest level – stating that this postcode lottery of support is unacceptable, and that any unspent money from 2016/17 is ring-fenced and made available for intended practices.
Also look out for our ‘GP Forward View: one year on’ report which will be released later this month, providing GPs with an objective analysis of the first year of commitments.
Meanwhile, practices should remind themselves of all the initiatives and funding streams available in the GPFV, as detailed in our Focus on funding document.
We will also be holding a special GPC/LMC conference on 26 April in London on ‘Implementing the GP Forward View’, to ensure that LMCs can support practices to access the funds and support they are entitled to. If you are an LMC member, please contact your LMC if you wish to register for a free place (maximum of two per LMC).
With best wishes,
BMA GPs committee chair
Meet the team – Simon Poole
As I have previously mentioned, the GPC executive is supported by policy leads in developing and implementing strategy, and delivering our key responsibilities. In this newsletter, I would like to introduce you to Simon Poole, the GPC policy lead for commissioning and new models of care.
Simon has been a GP partner in Cambridge since 1992, and was the chair of Cambridgeshire LMC for eight years. He has represented Cambridgeshire and Bedfordshire as the regional representative on GPC since 2005. Prior to becoming the policy lead for commissioning and new models of care, he was the elected chair of the commissioning and service development subcommittee.
Simon is also elected to represent GPC on RCGP council and the BMA public health medicine committee.
Simon also has a personal interest in lifestyle medicine, nutrition and the Mediterranean diet and is noted for the hip flask in his jacket pocket – not containing whisky, but good quality olive oil to be brought out and drizzled over lunch.
Commenting on his appointment to his current role, Simon said: ‘It is a real privilege to support the GPC executive team in developing policy in these areas. While everyone recognises the all too familiar and accurate description of the crisis of workload and workforce in UK general practice, there is nothing more inspiring than hearing from grassroots GPs and their LMCs who are making changes and developing new ways of working together, which we can help to disseminate to other interested areas.’
As GPC chair, my week is usually packed with engagements in representing the profession, and I thought I would take this opportunity to provide you with a short flavour of just some of the meetings I have attended in the past couple of weeks on your behalf, in addition to those I have mentioned above.
I recently attended a regular liaison meeting with the RCGP chair and officers to discuss areas of common interest to both organisations, and also spoke at the RCGP City Health Conference on new models of care; I attended BMA council which discussed the wider pressures facing the NHS but which inevitably impact on general practice; I had a productive meeting at the House of Lords with Baroness Walmsley and the Liberal Democrats parliamentary health team who have a welcome interest in the pressures facing GPs, and which was followed up by a helpful comment from the Liberal Democrat shadow health secretary, Norman Lamb, on the Government’s failure to meet its GP recruitment and retention targets, and their lack of plans to address the crisis.
I met with Sir Bruce Keogh, medical director of NHS England, on the delivery of the Five Year Forward View; last week I spoke at a North Staffordshire LMC/federation event, in which I heard about some excellent LMC-led initiatives on implementing Forward View initiatives, such as 22 practices having been trained in reception signposting to reduce demand on GPs, and the creation of ‘practice support teams’ to step in at short notice and create resilience in practices under pressure; I am additionally in ongoing contact and undertake numerous regular ad hoc meetings with senior directors at NHS England and the Department of Health on a variety of important ongoing issues such as Capita and the development of STPs.
Last partner standing guidance
GPs are increasingly, unfortunately, finding themselves in ‘last partner standing’ situations (commonly referred to as ‘last man standing’, and used to explain a situation where, due to either an exodus of partners and/or lack of successor partners being recruited, one partner – or perhaps more – finds themselves shouldering the full extent of the liabilities and obligations owed by the practice). GPC therefore produced guidance to help colleagues deal with that situation.
We know what a serious situation this can be, with partners being unable to retire or, should they decide to wind up the practice, being left to personally fund what can be significant financial liabilities. We hope that this guidance will help GPs to avoid or tackle such a situation.
Handing back your contract guidance
GPC has produced guidance to support practices that are under critical pressure and are considering handing back their GMS/PMS contract and winding up their business. The guidance looks at the consequences of termination and possible alternatives, but it does not go into detail about selling of assets, the payment of debts and liabilities, or the implications for partnerships and individuals of making staff redundant. These matters should be dealt with only after obtaining professional advice on the processes and procedures you need to follow and the potential liabilities you may face.
Remember that handing back a current GMS/PMS contract would almost certainly be replaced by a short-term APMS contract subject to open commercial tender. We therefore strongly recommend that practices consider alternative means of sustainability, such as practice mergers, super-partnerships or working in different models of collaboration. Practices are urged to contact their LMC in the first instance for help and advice.
NHS Property Services
We are aware that NHS PS (NHS Property Services) have now issued their ‘heads of terms’ to practices and would like to highlight to practices that these terms are negotiable on an individual basis. The terms should be a first step to a negotiation between NHS PS and the practice.
We are aware of ongoing issues that practices are experiencing with NHS PS and we have been meeting with NHS PS to highlight these issues and seek a solution. Our stance is clear: practices should not make any additional payments unless satisfied that the changes are duly payable and indeed reasonable.
If you are looking to proceed with a lease negotiation, it is vital that you understand your liabilities and undertake appropriate due diligence. We are aware that some transitional arrangements are being offered to practices for signing new leases and would stress that practices should enter into any such transitional arrangements only when they are satisfied with the lease conditions, including all the charges.
We will continue to meet with NHS PS so that a robust process is implemented for calculating reasonable service charges that are fair and good value for practices.
DDRB pay announcement
The DDRB (the Doctors’ and Dentists’ Review Body) has released its 45th report with recommendations for the pay and conditions for doctors in England, Wales and Northern Ireland.
While the 2017/18 GP GMS contract negotiations finalised in February set the pay rise for GP contractors, the DDRB pay award will apply to salaried GPs working in the NHS.
Responding to the DDRB’s recommendations, BMA council chair Mark Porter said: ‘Yet again the annual pay review is nothing other than a cover for driving down real pay in the health service. The DDRB is recommending just a 1% pay uplift for doctors, well below the current cost of living rise of 2.3%. In real terms, doctors’ pay has sharply declined in the past five years, with junior doctors seeing their income drop by 17% at a time when their morale has been badly hit by the Government’s mishandling of the new contract. Over the same period, consultants have seen their pay drop by 14% and GPs by 13%.’