Practical support to make GP Forward View a reality

21 September 2016
 
The GP Forward View is a welcome acknowledgement that general practice is struggling with financial, demand and workforce pressures - and needs immediate support.
 
Simon Stevens’ acknowledgement that GP funding had been cut more deeply than other parts of the NHS was accompanied by a clear warning about the consequences of continuing as we are.
“GPs are by far the largest branch of British medicine and as a recent British Medical Journal headline put it - if general practice fails, the whole NHS fails,” he said.
 
The NHS chief executive was highlighting not just the importance of general practice in its own right, but its crucial role in transformation policies designed to shift the burden of care from hospitals to local settings – a change that demands not just halting the slide of general practice into crisis but making it stronger in future.
 
The commitments of the GP Forward View are underwritten with some new funding – not enough perhaps to satisfy practices that have seen their income eroded through PMS reviews and the phasing out of the minimum practice income guarantee (MPIG), but enough to begin to address the most urgent issues, which are 1) to prevent individual practices from failing and 2) to enable them to develop the scaled up capabilities that will make them both fit for the future and able to play their part in bigger NHS transformation plans.
 
Most acknowledge that after years of underfunding simply boosting core GP contract income will not be enough.
 
But policy makers and commissioners want to see GPs shift their thinking away from basic rates of pay and deliver locally commissioned services over and above the core contract, and to work not just in their current configurations but in new groupings across bigger geographical areas and/or as part of more vertically integrated services. The new MCP contract is one way to encourage this change, but it remains to be seen if the attractions will be sufficient to lure GPs away from the security of the GMS contract.
 
Like the financial deal struck with the government for the Five Year Forward View, which saw new funding in return for a commitment on the part of the NHS to save money, the GP Forward View is not just intended as a financial sticking plaster. It offers not a bailout for general practice but a bargain: funding the development that will be needed first to make weaker practices sustainable and second to make general practice a stronger part of the bigger transformation picture.
 
This is a sensible approach as a sudden injection of cash won’t on its own have any effect on such problems as the shortage of GPs, the state of premises and strains on the wider general practice workforce created by rising demand and increased bureaucracy.
 
PCC is working with practices to support both the immediate operational and longer term strategic development needs acknowledged by the GP Forward View. This includes support to help practices identified as “vulnerable” to get back on their feet and get them into a position where they can stop fire-fighting and get longer-term development plans in place.

PCC has recruited experienced experts who we already have working alongside practices across England, helping those needing support to identify changes and to make sustainable improvements to their finances, workforce and business processes. Our comprehensive diagnostic covers practice performance, premises, staffing, patient care, practice management and contractual performance indicators. It includes rapid analysis of strengths and weaknesses together with recommendations and where needed support for improvement.

 
“The diagnostic provides important clues but the solution has to be to support the practice to make its own sustainable improvements,” says PCC associate director Mark Beesley.
We are also working with around 650 practices in the national clinical pharmacists in general practice programme, supporting practice teams to embed new members of the workforce who promise both to bring new expertise to benefit patients and to relieve workload pressures on GPs. Like the vulnerable practice work, the clinical pharmacists programme has the wider aim of starting longer term discussions about development at practice level.
We continue to work with practices that have already started thinking beyond the immediate practice unit. Our support for collaborative working recognises that practices in different areas are at different stages of the development journey, with some still making tentative plans and others beginning to work in new formal structures.
 
For example, we supported the East Lancs Union of GPs to agree its mission, vision and purpose, develop its identity and get practices signed up to the federation. Later we supported the development of the board resulting in a refocused vision and a strategic plan.
 
Carole Martin, the federation’s operational director, also took part in our Confident Leader programme, which allows local groups of aspiring leaders to learn and work through problems together in a programme lasting several months.
 
Carole said: “Working together means stepping out of your comfort zone. PCC helped us to appreciate what we needed to understand, but also provided the confidence we needed to make it happen.”
 
For further information contact Mark Beesley at mark.beesley@pcc.nhs.uk or 07920 500135.
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