Last month, we launched our survey of practices’ experience of the primary care infrastructure fund (now called the primary care transformation fund), in response to a growing number of concerns about difficulties with practices receiving support and funding to progress their schemes. This four-year £1bn infrastructure fund was announced last year after intense lobbying from the BMA GPs committee, and is intended to provide practices with much needed financial support to improve their premises, and on the back of four in 10 practices stating that they do not have the space to provide adequate core services.
We have today published our survey results, and I thank all of you who responded. We received more than 200 responses, almost a quarter of the 1,000 practices who have had their bids approved ‘in principle’ by the primary care transformation fund. The responses sadly reveal a picture fraught with delays, lack of clarity in processes and threats to the funding of approved schemes.
The key findings show:
- Of those with supported bids, 54 per cent experienced delays of more than six months
- ‘Lack of leadership or clear process’ and ‘lack of expertise within the local NHS England team’ were the main reasons cited for these delays
- Of those with approved bids, 83 per cent believe that the project will need to be extended beyond the March 2016 deadline to receive funding
- Around one in five (22 per cent) of those facing delays have been advised by their local NHS area teams that they could lose their funding altogether
- For all those that received initial approval, ‘refusal to meet recurrent costs by NHS England or the local CCG (clinical commissioning group)’ is cited as a major obstacle by a quarter (22 per cent) of respondents.
It was always unrealistic to expect such building projects not to suffer unexpected delays, and this has been fuelled by lack of clarity and delayed processes on NHS England’s own part, in particular via its area teams. It is therefore unacceptable that any area team should rescind funds on approved projects which have experienced delays. I have taken this up with national director for commissioning development at NHS England Ros Roughton, who has provided written assurance that there will be reasonable allowance for slippage into next year. Some area teams are clearly diverging from this assurance, creating further uncertainty and delays, and it is vital NHS England ensures consistency in implementation nationally.
It is important to restate that these funds are vital for GPs and practices to deliver core and expanded services, and patient care will suffer if resources are not deployed to improve the impoverished infrastructure of the GP estate. GPC will continue to press for the funds to remain in general practice and for a more robust framework to be put in place for the future years of the fund. Read the GPC press release, and find out more about thesurvey results. We have already received considerable coverage on the findings, including in Pulse and GPonline.
NHS England to fund winter GP out-of-hours indemnity costs
In my last letter, I stated that I had spoken at a recent indemnity meeting convened by chief executive of NHS England Simon Stevens. Following intense lobbying by GPC, it is positive that last week NHS England announced plans to make £2m available, to help with GP indemnity costs to GPs providing OOH (out-of-hours) care this winter – December through to March 2016.
In partnership with medical defence organisations, NHS England has developed a time-limited scheme to offset the additional indemnity premium GPs would incur when working additional OOH sessions. GPC has long argued that the significant extra costs to GPs doing OOH work is disproportionate, often deterring many from providing this extremely valuable aspect of general practice care.
While GPC welcomes NHS England’s announcement, this is a temporary short-term solution to what is a much wider problem, with indemnity costs having rocketed across all aspects of general practice provision, which is in need of a considered longer-term response. It is also unclear whether those doctors who have already paid additional fees to cover extra OOH shifts this winter, will have their costs reimbursed. GPC is seeking clarity on this.
Representing GPs at the Health Select Committee
Yesterday I gave oral evidence to the Health Select Committee primary care inquiry launched earlier this year. This fourth session of the inquiry focused on quality of care. I appeared alongside Royal College of General Practitioners Council chair Maureen Baker, and chief inspector of general practice of the Care Quality Commission Steve Field.
I was resolute that the current impoverished landscape in general practice was unsustainable, with a workload and workforce crisis in which 9 in 10 GPs state that they are unable to offer patients the quality of care they need. I highlighted the absolute need for the Government to provide tangible new resources for general practice in the front-loaded £3.8bn investment from the Comprehensive Spending Review, as well as much needed support and development.
Our discussion covered the following breadth of topics: the CQC inspection process; seven-day GP access; the risks to OOH services and general practice services more widely posed by steep rises in indemnity costs; the impact of GP workload on patient care; and approaches to reducing workload, including the support of other health professionals.
As always, you can keep in touch with the latest news on bma.org.uk/gpc
Best wishes,Chaand Nagpaul
BMA GPs committee chair
CQC comments on standards of care at GP practices
You will have seen reports in the media over the weekend on the comments made by Professor Steve Field about the alleged poor level of care at some GP practices.
These comments have been hugely unhelpful and a slur on the vast majority of GP practices who manage to provide good or outstanding service to their patients despite being under unprecedented pressure from rising patient demand, falling resources and staff shortages. It fails to recognise that many practices are unable to provide the quality of care they wish owing to context and constraints, such as recruitment problems or inadequate funding and premises.
While it is important that there is assurance of competence and safety in GP practices, the current inspection regime is disproportionate, bureaucratic, punitive and expensive and is desperately in need of review. You can read GPC’s response. I also made these points emphatically in my oral evidence to the Health Select committee yesterday.
GP practices workload pressures survey, please respond!
Help the GPC to create an online visual that will map areas of England, Scotland and Wales where practices are struggling with workload, recruitment, retention and financial viability. The closing date for responses is Wednesday 23 December. We need as many practices to respond. Complete the survey.
Is your practice at risk of costly mistakes?
As a GP employer, understanding the finer details of employment law is a vital part of your role – any mistakes could lead to costly tribunals and wasted time. BMA Law’s employment law diploma is the ideal way to make sure you have the knowledge and confidence to deal with employment issues, ensuring your practice is always on the right side of the law. Find out more
Junior members forum 2016: register now
From 23 – 24 January 2016, the BMA will host a junior members’ forum in Manchester.
This two-day conference will give junior members a unique opportunity to get involved with the BMA and start making a difference to the future of your profession.
This year’s conference will include BMA junior doctors committee chair Johann Malawana speaking on the proposed new junior doctor contracts as well as opportunities to discuss other issues important to you.