The Future of General Practice
GP providers across the country are increasingly working together in federations, networks and super-partnerships to operate at a larger scale and benefit from economies of scale, shared services and quality improvement, by adopting a consistent approach to best practice.
General Practice Forward View
The GP Forward View, published in April 2016, sets out NHS England's plan to transform general practice. NHS England intends to commit an extra £2.4 billion a year to support general practice services by 2020/21, which will be supplemented by a one-off five-year £500 million national Sustainability and Transformation package to support GP practices.
Summary of key points:
- Workforce: There is an aim to increase the number of GPs by 2020/21 through incentivised training, recruitment, retention and return to practice schemes. NHS England is offering bursaries to attract GP trainees to work in areas of the country where GP training places have been unfilled for a number of years and investing in 13 pilot training hubs to extend the skills base with general practice.
- Workload: There are plans to aid struggling practices, changes to streamline the CQC inspection regime, support for GPs suffering from stress, and cuts in legal red-tape and bureaucracy. This will include streamlining payment process for practices and an investment in technology to automate common tasks.
- Infrastructure: Investment in new technology to enable patients to book appointments more easily and enhance consultation and workload management systems. There are new proposals to permit up to 100% reimbursement of premises developments to enable upgrades to practice premises. NHS England is offering to fund Stamp Duty Land Tax for practices who sign new leases with NHS Property Services until the end of October 2017.
- Care redesign: Increased support for new super partnerships/federations, direct funding for improved in and out of hours access, along with a new voluntary multi-specialty community provider contract aiding integrated primary and community health services.
Opportunities for General Practice
New digital technology often requires upfront capital investment which can discourage GP practices; however, the results can generate a significant improvement both to the GP practice and to the patient experience. Practices are improving their websites to signpost patients to the most appropriate service; sending text messages as appointment and vaccination reminders; developing smartphone apps to support patients to self-care; offering Skype appointments for patients at home; and carrying out consultations via webcams in care homes.
There is currently a recruitment crisis in general practice; workforce development and retention is a crucial issue to address. Many in primary care are therefore looking at new workforce models, with the aim of freeing GPs from the burden of administration and managing a business, to enable them to focus on the delivery of patient care. This is likely to mean more salaried GPs providing clinical services, supported by a dedicated management team operating over a larger primary care footprint.
In June 2016, local CCGs submitted recommendations to NHS England for further investment in the GP estate. The key driver for this investment is to improve existing facilities and increase the flexibility to accommodate multi-disciplinary teams. Increasingly, GPs are considering the possibilities and mechanisms to consolidate their estate. This might involve relocating back office functions to one site, managed by a federation. This in turn can increase the space available for patient consultations and in some cases allow for sub-letting of space to pharmacies and community service providers, increasing the range of services available to patients under one roof.
NHS England's Multi-speciality community provider framework builds on lessons learned from the 14 MCP vanguards. The aim of an MCP is to create a more efficient and joined-up pathway of patient care that bridges the gap between primary, community, mental health and social care. At one end of the spectrum, GPs will continue to hold their own GMS/PMS contracts and operate under an alliance contract with partners. In its most integrated form, the MCP will hold a single, whole population budget for all the services it provides, including primary medical care services. Amendments to the primary care legislation are currently being considered in order to enable GPs to suspend their GMS/PMS contracts for a defined period, giving GPs time to collaborate and integrate with other providers to develop MCPs, with a safety net of being able to return to former contractual arrangements should they decide to do so.
One of the key challenges for GP providers in forming federations or super-partnerships, is being able to engage a wide group of individuals whose interests may not be aligned at every point. One way in which this challenge can be addressed is by ensuring that there are clear objectives set – for example, there may be particular services that the GP providers are bidding for that drives the collaboration or clear savings to be made through shared services arrangements. This should be documented clearly, along with the roles that each provider is expected to carry out and how decisions will be made. Forming a company or super-partnership is just the first step in a long journey but, done properly, it offers significant opportunities for GP providers.
GP providers do not have access to the NHS Resolution (formerly the NHS Litigation Authority) indemnity scheme and the cost of arranging indemnity cover has significantly increased in recent years, due to a rising number of claims and level of awards made by the courts. Providers are looking at how personal costs of indemnity can be limited – for example, when working in an MCP or PACS model, a new entity could take on corporate insurance which individuals have the benefit of. The Department of Health, NHS England and NHS Resolution are currently working together to find solutions, including introducing a Fixed Recoverable Costs Scheme to cap the level of recoverable costs.