Saturday, 24 June 2017

Notes from RCGP Council meeting 24 June 2017

Physician Associates

Council did not approve the following draft position:
The RCGP is committed to working with governments across the UK, physician associates and our members to ensure that physician associates in general practice work safely and effectively as part of a GP-led multidisciplinary team to support and provide continuing, high-quality, integrated patient care. Physician associates should be seen as new members of the clinical team, complementary to GPs, rather than a substitute for them.
I made the following points:
Having canvassed opinion on this matter, I can say there is still considerable anxiety amongst GPs on this matter. Hearteningly, some critics have latterly been working with physician associates and found that, with tightly defined roles, they are valuable members of their team.
It is vital that the optimum role of physician associates in general practice is defined carefully, as well as resolving issues including regulation, standardisation of training, continuous professional development and revalidation.
There is much anxiety about the role of physician associates in general practice, how efficiently they consult, and how burdensome it will be for GPs supervising them in terms of time and carrying risk.
By virtue of medical undergraduate training, on-the-job acute hospital experience and GP specialist training, GPs are second-to-none amongst professionals at managing undifferentiated presentations.
The literature I have found demonstrates that PAs are at best as cost-effective as GPs (without considering costs of supervision) when consulting a pre-selected, less complex cohort. Indeed, that cohort (triaged by receptionists) was also less affluent, which reinforces concerns about accentuating health inequality.
I would suggest that our position make reference to cost-effectiveness rather than just effectiveness and that any impact on colleagues (thinking about costs such as time and risk) be fully mitigated.

To be completed ....
 
 
 
 

Tuesday, 11 April 2017

What's So Good About GPs Being Independent Contractors?

GPs are not directly employed by the NHS. GP principals (who usually work in partnerships and may themselves employ other, salaried, GPs) are contracted to NHS England for the work that they do. They are free to undertake private work (such as providing insurance and legal reports) but the vast majority of their work is for the NHS.

Palace of Westminster, London - Feb 2007.jpg
By Diliff - Own work, CC BY-SA 2.5, Link

Therefore, GP principals are in the unique position of deriving the vast majority of their income (from which they will also have to pay for their expenses such as nursing and administrative staff) from one employer but being independent contractors.

GP principals have a great degree of autonomy over how to run their practice (which NHSE and governments may find frustrating) and are motivated to work long hours (sometimes longer than healthy) completing the work their patients need from them. They can be well rewarded but also carry the risk for employing their staff: if the practice fails financially, they can be personally liable.

As such, GPs as independent contractors offer unparalleled value for money for the NHS.

Unfortunately, in recent years, the work required has mushroomed and the funding, as in much of the public sector, has been squeezed. As such, the responsibility, workload and risk has been daunting for many. Many GPs have left the workforce and not enough have been trained. There has been a reluctance in some cases to share profits with newer colleagues even if they wanted partnership.

Consequently, unless substantial new resources are forthcoming, the model of employing GPs as independent contractors is under threat.

In the report of the House of Lords Select Committee on the Long-term Sustainability of the NHS, it was suggested that the independent contractor status of GPs as a model of funding was "not fit for purpose" (page 23 para 71). This is only because of years of the model being sabotaged, some would argue deliberately.

What is urgently needed is proper funding for General Practice, otherwise the ICS model will be only one of the first casualties. Certainly, without new resources, we will in the interim need to find new and less efficient ways of working, probably using directly employed GPs and other staff.

My declarations of interest
I have been a GP for nearly 13 years, of which 4 have been as a partner of a large multisite partnership (Midlands Medical Partnership). I am currently a salaried GP at Sandbach GPs, Ashfields Primary Care Centre and am looking for a partnership to join, as I believe in the ICS model and that it has a future. I am standing for re-election to the Council of the Royal College of General Practitioners.)

Postscript 30 April 2017

According to a poll of nearly 850 GPs run by +Pulse Today, 57% believe the partnership model has no long term future and only 20% believed it would still exist 10 years hence.

Friday, 24 February 2017

Notes from RCGP Council meeting 24 February 2017

Storm Doris notwithstanding, there was a packed agenda. In a departure from tradition, education and innovation items were considered before politics, which allowed for more focus on the former.

Faculty Finance

I asked for some detail relating to the implementation of a change of administrative policy that had caused concern in my Faculty.

Referral management

I welcomed an excellent paper from the ethics committee summarising not only the limitations of referral management but also of the drivers of increased activity and financial pressures that are often blamed unfairly on GPs.

They reached the conclusion, important in my view, that prioritisation should be explicit, even though this is politically unacceptable. This supports my long-held view that, as well as healthcare funding, the electorate must consider the remit of the NHS. I called for College to campaign for prioritisation to be considered explicitly, perhaps as part of the ongoing Put Patients First campaign.

RCGP Clinical Priorities 2017-2020

Council approved the following clinical priorities: cancer (to March 2022); liver disease, mental health, physical activity and lifestyle, and sepsis (to March 2019) as well as a number of 12 month "spotlight projects".

I questioned how the recommendations of each project would be weighed against the five tests of overdiagnosis agreed by Council in 2015. It was agreed that the RCGP Overdiagnosis group would be kept updated on the work of the Clinical Innovation and Research Centre.

Fellowship and beyond

A discussion paper was presented on ideas to improve the uptake of fellowship across the demographic of College members, and College might support continuing professional development for fellows.

I reiterated my view that fellowship should be open to all GPs, including those who are not existing RCGP members. I also expressed concern that a CPD programme might lead to "higher" designations of fellowship, thus devaluing fellowship itself.

*update: I have since joined the FRCGP short life working group seeking to inform policy in this area.