Seize your chances to get one step ahead
GPs and practice managers need to act on an important NHS policy document so they can turn it to advantage for their practices. Deborah Wood** casts an accountant’s financial eye over the General Practice Forward View
Over the last decade investment in secondary care specialists has grown three times faster than investment in GPs in primary care. Now, at last, the NHS seems to have recognised this imbalance needs redressing.
NHS England’s General Practice Forward View document, published in April 2016, sets out practical ways for this to be dealt with over the next five years and includes information on additional funding for investment in staff, technology, premises, indemnity, bureaucracy and care redesign.
The aim of the support package is to reinvent the clinical model, the career model and the business model to reinvigorate general practice.
Keeping general practice at the core of patient-centred, co-ordinated, high-quality community care that encompasses the complexity of acute, long-term, mental and social care is the goal.
The GP’s role will be to lead multi-disciplinary teams linking hospital, community and social care professionals to provide co-ordinated care for their patient list. This is likely to be in a networked, collaborative environment in which specialisms can thrive.
Greater use of technology will also be a key component for making these ideas work.
GPs and practice managers need to be abreast of what is in the document so that they can consider what is available to their own practices at a local level.
£2.4 billion a year to 2020-21 is on the table, which represents a 14% real terms increase. For 2016-17 this means that an additional £322m is allocated into primary care.
In addition there will be a Sustainability and Transformation package of £508m over five years to support struggling practices, develop the workforce and stimulate care redesign.
Each area in England has to produce a plan to secure and support general practice by July 2016. This funding includes £56m for a practice resilience programme starting in 2016-17, £206m to grow the workforce, and £246m for service redesign.
The practice funding formula will be recalculated in the summer of 2016 to reflect workload, deprivation and rurality issues. PMS reviews are being phased in over a minimum of four years requiring a published reinvestment plan for local savings before full implementation.
Proposals to find ways to tackle the high cost of indemnity for GPs are being developed from July 2016.
From April 2016 CCGs, local authorities and NHS England are able to pool their Better Care Fund budgets to jointly commission services including nurses in GP settings to provide a co-ordination role for patients with long term conditions; GPs providing services in care/nursing homes; providing mental health care professionals in a GP setting and hosting social workers in GP surgeries.
Ambitious targets have been set by NHS England together with Health Education England to double the rate of additional doctors coming into general practice over the next five years. This means an increase in GP training recruitment to 3,250 a year to support 5,000 new GPs by 2020. As I write, there has been a 70% take up of places for 2016-17.
There are bursaries of up to £20,000 available to attract 109 GP trainees into under-doctored areas and a national induction and refresher scheme offers a £2,300 a month bursary during the supervised period for returners.
In addition to trying to attract new and returning doctors into general practice there will be:
* investment in 3,000 additional mental health therapists
* existing investment in clinical pharmacist positions to be increased to expand the programme by a further 1,500 pharmacists in general practice by 2020,
* £15m investment in training capacity in general practice for nurses
* £45m to support training for reception/clerical staff
* 1,000 physician associates to be trained
* pilots for medical assistant roles
* £6m for practice manager development and
* £3.5m for multi-disciplinary training hubs.
And there is also £16m on top of the £3.5m previously announced to be invested in specialist mental health services to support GPs themselves who are suffering from stress and burnout.
Research suggests that workload in general practice has increased by 2.5% a year since 2007-08, with 27% of GP appointments potentially avoidable.
A £30m development programme ‘Releasing time for patients’ will facilitate patients to self-manage their illness and practices to support people with long-term conditions to self-care and influence the involvement of community pharmacy.
There will be some tightening up of legal matters in NHS Standard Contracts to help prevent workload shifting inappropriately from secondary to primary care with CCGs responsible for monitoring this.
Pilot sites are operating better communication methods between GPs and consultants to access advice and minimise referrals. Use of IT systems that simplify the process for new care plans are to be actioned for 2017-18.
In addition, £40m of additional funding over four years is available for practice resilience plans.
BMA roadshows have provided advice on 10 actions to create capacity.
On the back of CQC inspections to date, 87% of practices have been found to be good or outstanding so five yearly reviews are to be instigated. Along with professional indemnity fees, CQC registration fee increases are reflected in the annual Review Body pay award.
QOF is to be reviewed and it is likely that the unplanned admissions enhanced service will cease at 31 March 2017.
GP practice data collection and payment systems are to be simplified. CQRS data can be entered manually to avoid cash flow problems. The payment systems providers will be expected to improve their accuracy and to develop a payment claim/reconciliation tool.
Computerised paperless systems and integration across NHS organisations is also moving forward.
Various initiatives are in place to create best practice guidelines for practice workload/appointment management. Interaction with social prescribing and the Fit for Work campaign is intended to reduce the burden on GP practices.
£900m is included within the overall investment funds for capital investment over the next five years. New rules are being created to enable NHS England to fund up to 100% of premises development from September 2016 (currently 66%).
Practices that are tenants of NHS Property Services will be encouraged to sign new leases from May 2016 to October 2017 and their stamp duty land tax costs will be funded.
Transitional funding for practices seeing significant increases in facilities management costs within leases held by NHS Property Services or Community Health Partnerships will be available from 1 May 2016 to 31 October 2017.
CCGs will be allocated an 18% increase in funding for IT services and technology for general practice.
Online access for patients, online consultations, an approved medical apps library, Wi-Fi in practices, and communication improvements are all being funded via a £45m national programme.
This will include integration of extended access with out of hours and urgent care services involving reformation of the 111 service to ensure there is sufficient access at evenings and weekends and working at scale through access hubs.
The new Multispeciality Community Provider Contract is being developed for April 2017 to create a new clinical and business model based on the patient list. Funding will be for the whole population budget and for the full service range.
Working at scale is encouraged to develop economies of scale, quality improvements, assist with workforce development and redesign delivery of care services.
Federation systems are envisaged to provide resilience by sharing back-office functions and pools of staff.
The General Practice Forward View certainly contains a lot of useful ideas about how to improve the current situation for general practice. There is a mixture of new funding and redeployment of existing funding together with best practice guidelines which should all help.
Practices need to get close to their CCGs and check out the plans for how the various investment funds will be allocated to ensure they are getting access to their fair share.
There is a clear need to do something different in general practice but is the five year turnaround time achievable or too ambitious? Is there enough fighting spirit left amongst the GP leaders to roll their sleeves up and make it work? Will all the parties collaborate together sufficiently quickly to make change happen?
It is incumbent upon the GPC and RCGP together with CCGs and member practices to steer the implementation process effectively to ensure that general practice continues to be fully sustained, not just for the next five years, but also for the next generation.
Subs – for runners and riders
**Deborah Wood is AISMA vice chairman and head of Healthcare Services Moore and Smalley LLP
This article first appeared in the Summer 2016 issue of AISMA Doctor Newsline, the newsletter of the Association of Independent Specialist Medical Accountants.
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