Tackling the challenges GPs face

Tackling the challenges GPs face

 The unique strength of GPC as your representative body comes from its infrastructure of LMCs — it democratically represents the interests of general practice across the UK.

It is vital GPC connects with and understands everyday GPs on the ground, which is why we go out and speak at your local and regional meetings throughout the year.

We run a series of national GPC roadshows twice yearly, which are open to all GPs and hosted by LMCs (local medical committees). These have been running this month in more than 10 areas across England.

Last week I spoke at Beds and Herts, Kent, and West Midlands LMCs, which gave me an invaluable opportunity to report on the work and priorities of GPC, and most importantly to hear directly from grassroots colleagues about their issues and concerns, coupled with lively debate on how to move forward together to address the challenges ahead.

These meetings cover issues including:

  • Forthcoming changes to the GP contract
  • Managing workload
  • Co-commissioning
  • New models of care
  • Workforce
  • GP premises.

You may still have time to attend a roadshow in your area.

 

Workload

A constant theme in the roadshows has been our excessive and unmanageable workload. I was pleased that so many practices are finding our guidance on managing workload, Quality First, useful.

One GP who has a partnership vacancy, and was fortunate enough to have applicants, told me that as part of the interview process prospective partners were asked to use our guidance to present a practice-workload management strategy.

Another GP recounted that in a recent CCG (clinical commissioning group) practice visit, he used our guidance to draw up a list of 20 things that the CCG could do to support him and other local GP practices.

CCGs have commissioning powers to implement simple changes to address the daily obstacles and inappropriate workload generated from other sectors.

If you have not done so, I recommend reading our guidance, and working with other practices and your LMC to develop a local coordinated approach to managing workload and demand.

Vanguard sites for new models of care

Yesterday, NHS England announced 29 vanguard sites, selected from 269 applications, to develop new models of care as described in its Five Year Forward View.

These projects will be funded from a £200 million transformation fund, and will be subject to an evaluation with a view to replicating successful models elsewhere. Fourteen bids are to develop multi-specialty community providers, eight to explore primary and acute care models and seven to develop enhanced care home projects.

These models signal radical changes to the current organisational and transactional model of the NHS in England. If implemented properly and led by clinicians, these models have the potential to break down disruptive organisational barriers between GP, hospital and community services, which are wasting resources and increasing workload.

Read the BMA’s response.

For GP practices there are far too many instances of time-consuming bureaucracy such as:

  • Re-referrals of patients from one service to another
  • Perverse incentives that result in inappropriate shifts of work into general practice
  • Community nursing teams being disjointed from GP services
  • Daily chasing up of patient care, which can be lost in the fragmentation of care across different systems.

GPC is in dialogue with NHS England regarding the implementation of these models and how they will affect GPs.

I have made it clear that these changes must deliver NHS England’s stated commitment in the NHS Five Year Forward View to address the gross under resourcing of general practice, and the need for a shift of resources from secondary to primary care to reflect the escalating volume of care transferred out of hospitals.

It is also vital that the essential strengths of the personalised care provided by GPs to registered lists of patients are maintained.

This announcement comes on the back of more revolutionary proposals by chancellor George Osborne to allow Greater Manchester to take control of its health budget from April this year. The 10 councils, 12 CCGs, 15 NHS providers and NHS England will control the budget and deliver services including adult, primary and social care as well as mental health and community services, and public health. It will also focus on preventive work in the community, partly to ease pressure on hospitals. Given there is no detail of how this would work, it raises more questions than answers.

GPC will be keeping a very close eye on this development as well as representing GP practices via their LMCs and working to ensure that GPs on the ground in Manchester and in the vanguard sites are able to contribute to the development of these models, which will have such an impact on their working lives.

We would advise GPs to work with your LMC, and exercise your rights as CCG members, to ensure that any changes are fully thought through and in the best interest of GPs and patients.

CQC guidance for practices

A CQC (Care Quality Commission) visit is a daunting prospect for any practice, and is much more so if GPs, practice managers and staff are not clear about how to prepare for an inspection or what is expected on the day.

I am pleased to say that we have just launched GPC guidance on preparing for a CQC inspection, which has been drawn from information from several LMCs as well as the direct experience of practices themselves.

This practical guide includes helpful tools including a checklist, a presentation brief, key questions an inspector may ask and general hints and tips.

I hope you will find this useful – please let us have your feedback, including any experiences from your own CQC inspection.

You can also add your ideas and engage in debate on CQC on the BMA Communities website.

Meanwhile, GPC continues to oppose the wider flawed elements of CQC inspections, such as ratings of practices, and the intelligent monitoring process.

We are involved in an ongoing basis at various CQC meetings, and any feedback you have will be extremely valuable in order to represent your views and put pressure for change where necessary.

 

Finally, don’t miss the latest news from GPC.

 

With best wishes,

Chaand Nagpaul

BMA GPs committee chair

info.gpc@bma.org.uk

bma.org.uk/gpc

Welsh LMC conference

I was delighted to attend the recent annual conference of Welsh LMCs, and would like to thank conference chair Eamonn Jessup and BMA Welsh GPs committee chair Charlotte Jones for their hospitality.

The conference highlighted considerable differences in the environments GPs work in across the four nations, such as the notable absence of CCGs, alternative provider medical contracts or competitive procurement in Wales.

However it also brought home to me that we share the same vexed challenges:

  • Excessive and inappropriate workload shift
  • Problems in recruitment and retention
  • Inadequate premises and staffing
  • Rising demand from an ageing population with multiple complex needs.

Going back to the issue of CQC inspections, it was notable that the conference supported the sensible and proportionate approach to practice inspections by Health Inspectorate Wales – a sharp contrast to the considerable disquiet about the CQC inspection process in England, which has instead become a league table of simplistic, skewed ratings of practice performance without context.

Two-year contract agreed in Wales

A two-year contract to provide GPs in Wales with greater stability has been struck.

The deal agreed between the BMA and Welsh Government is a departure from the usual one-year agreements.

It aims to cut bureaucracy and free up GPs’ time by moving money set aside for quality targets into core funding.

The GMS (general medical services) contract for 2016/17 also continues to place a focus on the development of GP cluster networks, which aim to improve patient care in the community.

BMA Welsh GPs committee chair Charlotte Jones said: ‘This agreement, reached with the Welsh Government, will give practices a degree of stability, knowing what their financial flows from the GMS contract will largely be.’

Changes include returning 101 QOF (quality and outcomes framework) points to core funding.

Dr Jones said: ‘The change to QOF recognises the high-quality care embedded in general practice and enables practices to continue to focus on managing the individual patient rather than simply chasing targets.’

Other commitments under the 2016/17 contract include:

 

  • A review of the care homes enhanced service
  • A diabetes enhanced service
  • Completing a review-of-service fee in relation to vaccinations and immunisation
  • Practices to offer more GP appointments and repeat prescriptions online.

Welsh health and social services minister Mark Drakeford said: ‘The two-year agreement reached with GPC Wales directly addresses GPs’ concerns about unnecessary bureaucracy.

‘This places more trust and reliance on the professionalism of GPs to use their clinical judgement.’

GPC in the news — recruitment crisis

The BMA had a major push on the problems affecting GP recruitment and services in general last week.

Our media office briefed the BBC heavily for their Inside Out programme, which aired on Monday, 2 March.

In addition, a press release that went out the preceding Sunday resulted in GPC representatives receiving 169 mentions in regional newspapers, conducting interviews with more than a dozen radio stations and TV stations, and appearing in a host of national newspapers, including the Guardian and the Daily Mail.

Later in the week, we organised a special all-morning broadcast from a surgery on BBC Sussex to highlight the pressures on GPs as part of our Day in the Life (of a GP) project.

Read Pulse and GP magazine coverage on the vanguard sites.

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