Friday 19 June 2015

New deal for General Practice?

Today, Jeremy Hunt set out his new deal for general practice that he started work on amid much fanfare only one month ago. GPs struggling to cope with the burdens of increased demand and accelerating retirements had been awaiting this eagerly. RCGP had published its Blueprint for General Practice, setting out what General Practice urgently needs. How much of this has been heeded?


This was presented as a quid pro quo: in return for investing in General Practice, GPs are asked to:

Work 12 hours per day 7 days a week

An election manifesto commitment. Still no hint as to where the resources necessary for such a change will come from. Clearly the driver here is to reduce hospital workload: one might naively suppose that resources might accordingly be diverted from hospitals to General Practice.

Undertake social prescribing

Again, no suggestion as to how a service struggling to meet its current obligation might be able to undertake such an enormous new area of work. Closer integration of health and social services and their budgets has been suggested, but does it really make sense to use up more of the scarce resource that is the General Practitioner in this way?

Have a bigger role in Public Health

Might General Practice be expected to pick up the pieces of a Public Health service underfunded by Local Authorities? How is this to be resourced?

See publication of outcomes data

In spite of CQC's much-derided experience of publishing "Intelligent Monitoring" data (remember its description of GP practices "at risk"?!), Mr Hunt seems determined to continue this approach. How this could support a "change in culture – from name and shame to learning and peer review" is not clear, although such a change in culture is long overdue.

New commitments

So what new commitments has the Secretary of State for health made today?

£7.5m to Community Pharmacists

This will be diverted FROM  the Primary Care Infrastructure Fund set up to build new GP premises.

650 new GP training places

1,000 Physicians' Associates by 2020

Physicians' Associates had already been promised, but now we have a specific number. There remains debate as to exactly what their role should be.

4,000 practice nurses, district nurses and pharmacists

There is currently a surplus of pharmacists, so presumably these will form the bulk of this 4,000. RCGP and RPS are calling for finance from NHS England to support the introduction of practice-based pharmacists. There was no confirmation of such an arrangement in this speech.
Nurses are sorely needed, but Mr Hunt has said nothing today about how they might be recruited.

Clinical staffing data

Sure, this may help workforce planning. Why ever is this data not already available? What we really need, however, is detailed GP workload data. HSCIC even stopped collecting consultation rate data in 2008. The Nuffield Trust attempted to assess GP workload: it found consultation rates to be stable but hypothesised that "non-direct patient work", which it could not measure was taking up a disproportionate amount of GP time.

New ideas

There was just one new suggestion with no specifics:

Reduce bureacracy

Old commitments

£10m for struggling practices

It seems likely that this is not a new commitment, but part of the Primary Care Infrastructure Fund.

Clearly, within a national context, £10m does not buy a lot of GP time (ca. £1,000 per typical practice, £250 per GP or less than 20p per patient). However, if this is targeted sensibly, it could save a small number of practices (perhaps 40-100).

Extend GP training by one year in some areas

This something RCGP has been calling for nationally for some time. Unfortunately, this commitment is limited to certain areas and at least part of the extra year will be spend in hospital specialties, so General Practice will not immediately feel the benefit of an extra pair of hands.

Part-time working scheme to retain GPs close to retirement

More recycled ideas included:
  • 5,000 new doctors - an old promise. Where will they come from? That would require a doubling of GP training
  • A "pre-GP scheme" to encourage medical students to choose General Practice which has already been running for at least a year
  • A "marketing campaign" which RCGP has already started and apparently attracted 300 new recruits
  • A GP returner scheme which has so far attracted just 50 GPs
  • The £1bn Primary Care Infrastructure Fund - very welcome, but is a one-off fund for buildings, not GPs


In summary, Mr Hunt has a great deal on his wishlist, but will not provide General Practice with anything like the resources required to deliver it. Undoubtedly, some practices will succeed in some areas. Sadly, this may be at the expense of other practices and their patients. Yet another postcode lottery.
It is worrying that he is unable to be honest with the electorate that he is out of ideas to deliver on his over-ambitious promises. Is he really unable to "change consumer expectations of healthcare provision" or is he just unwilling to face the electoral consequences of promises he never expected to have to deliver on?


Farah Jameel said...

Excellent synopsis John. What a lost opportunity today to come in with much needed support for General Practice.

As far as I can see it, there's nothing new in today's "New Deal" other than clarifying the additional workforce plans & cementing plans for 7/7.

John Cosgrove said...

Thanks for pointing that out, Farah. I have updated accordingly