Still love the NHS and proud of General Practice
They are over-counting GP trainees. For a number of years the full time trainee has been counted as 1.067 FTE. Meaning another 7 FTE trainees in the figures for every hundred full time trainees in post. For the last 12 months the data has come from HEE and includes Foundation doctors in GP placements.
Also the GP registrar full time contract is 40 hours. The NHS Digital definition of FTE is 37.5 hrs per week. So every full time registrar is counted as 1.0666666667 FTE GPs. This has inflated trainee numbers over recent years.
HEE publish recruitment data about “acceptances” to training rather than commencement or completion of training. These data too are inflated, since some applicant hold places and reapply following years.
The move to lead employer, taking data from Electronic Staff Record meant that location data under old NHS Digital collection methodology was becoming increasingly inaccurate. HEE TIS ought to be an improvement for location data, which is relevant to local workforce planning.
RCGP could call these inaccuracies out as they have high quality data from e-portfolio that could give genuine insight into throughput, stage of training, locality and output.
Poor data leads to poor information leads to poor workforce decisions. But we know that because we’ve lived it!
Please no lazy journalism! “However when registrars are included....” is inaccurate.
NHS Digital have changed their counting methodology and are now getting GP placement information from HEE Trainee Information System (TIS). This should be a red flag when there is a shift in numbers. Noise signal.
The footnote indicates that the GP registrar figures now include Foundation doctors in GP placements. I have long been irritated about counting specialty trainees as GPs. NHS Digital does not count specialty registrars in other specialties as “consultants”. In my opinion counting foundation doctors as GPs is a step too far and the RCGP and BMA should call NHS Digital out on this one instead of meekly accepting fake news.
I have not seen the individual level data so I don’t know how much of the “growth” can be attributed to foundation doctors. There may be genuine growth in GP registrars. However it is not training throughout that matters, but (i) output and (ii) conversion to substantive NHS workforce. The assumptions for both of these in all the stock and flow models that I have examined are wildly optimistic.
Agree with Andrew Jackson. “Accepted posts on GP training programme” is not the same as commencing GP training. Deferred entry is increasing each year since its introduction and a significant proportion of those who defer entry never actually start GP training.
It is not training input or throughput that should be measured but training CCT output and conversion of that output to substantive NHS GP posts.
The assumptions that are being made for training attrition, conversion to substantive NHS GP posts and participation are wildly optimistic, in my opinion.
Ask NHS England for their stock and flow workforce modelling tool and look at the “default assumptions”.
First you tell them that there is a problem and they say there isn't a problem. Next they say that you are the problem.
I regularly visit surgeries across our area. GP practices are embedded in the communities that they serve. The staff are drawn from that community. We and our staff live, shop and send our children to school in the same places as the patients. The photos on the walls speak of history - a partner opening the building, a memorial to a patient who donated towards a piece of equipment, long service awards to staff members.
This stuff is intangible and valuable. There is a psychological contract.
Merger, federation, apps that cherry pick low risk patients: these are potential destabilisers of something precious that will be missed if it disappears.
Look after one another, you are valuable.
GPFV: negative reward prediction error
Go back and look at the chart in the GPFV. The numbers keep getting re-based. The starting point for the 5,000 additional GPs in the GPFV was over 35,000 FTE GPs.
Ah, back in the day. Where "curation of information" from the hospital required a receptionist with the origami skills to fold an A4 letter into the perfect size to put in a Lloyd-George envelope....itself perfectly sized to fit in a Boer War era military dispatch box.
Edwin, that is why they have changed the definition of FTE and allow one headcount GP to be counted as two full time equivalents if they work 75 hours. Their new definition means that over 3,000 GP trainees are counted as 1.06 FTE GPs.
Be careful what you wish for!
We've never had it so good?
Someone should do an FOI to see the variation. I bet some areas have done better than others.
I wonder who is going to fund this service and whether the return on investment would be as great as allocating the funds directly to the practice?
I wonder who is going to staff these NHS treatment rooms and how, in the context of massive workforce shortages, this will not bid up labour market costs for the practices or worse still, pinch practice staff?
"Asked whether the practices, which are all based in the Manningham area of Bradford, had the capacity to take on the added workload, the CCG told Pulse that all of the practices currently have open lists accepting new patients"
According to NHS Digital Bradford City has 127,000 registered patients and 48 FTE GPs excluding registrars and locums, but presumably including the GPs employed in the APMS providers.
Even if all the APMS GPs are redeployed in the PMS/GMS practices, this would mean an average list size of 2,646 per FTE GP including salaried GPs.
Lose just 5 FTE GPs from the three APMS providers that are closed and the average list size jumps to almost 3,000 pts per FTE GP.
In the last detailed stats 3 Bradford GPs were aged over 70, 2 aged 65-69 and 2 aged 60-64. I would suggest that it wouldn't take a huge surge in workload for these individuals to leave.
Contagion is an issue with a cascade effect from closures. If the dominoes start to tumble, it is very difficult to put it right.
Protect and value what you have, don't roll the dice without weighing up the risks/benefits. Have a contingency plan. Be open about it.
Relying on lists being open is not a plan, it is reckless.
One problem is the length if time that it takes for liabilities to fall due for payment. This is the virtue of a membership defence organisation: that it takes care of the "litigation tail" for members who have stopped working and stopped contributing.
It is a log "tail". Some cases take 20 years to settle. In the near future cases settled after 20 years that will have the discount rate removed will be funded from today's fees.
Meanwhile crown indemnity for secondary care has removed the necessity for many secondary care doctors to have full membership of defence organisations for much of their work. The NHSLA liabilities for secondary care alone now exceed the annual cost of delivering primary care general practice, so this is a substantial shift of responsibility from MDO to Crown liability.
Rising claims, falling sessional membership, greater proportion of MDO fees recouped from GP members.
I fear that GPs have been left holding the baby in some sort of horrible inverted Ponzi scheme.
Surely Government needs to intervene in this false market?
Actually Gabapentatryptacodone is correct about the seasonal variation. You need to look at the joiner leaver data to see it though!
The registered list in the sample increased 6.2%, the number of contacts in the sample increased by 7.5%. I think the conclusion drawn that contacts are growing faster than population in the sample studied is reasonable, though there is always a possibility that we are seeing better recording of non face-to-face contacts, rather than a true increase in activity.
Outside the sample the population/list size growth is 7.2%. If the number of contacts has grown in the wider GP provider community in the same way as in the sample, you might estimate contact growth of as much as 8.7% in two years in the rest of general practice.
If you look at prescribing item growth over a ten year period, it is around 4.5% annual growth.
It does seem reasonable to conclude that practices are meeting some increased demand, despite a falling GP workforce, largely through skill mix and new ways of engaging with patients.
I see lots of GPs working harder, still putting in discretionary effort and offering amazing value to the NHS.
Also there are more than 3,800 individual GPs who are counted as more than one full time equivalent. You work long enough....they are allowed to count you as two full time equivalent GPs.
The number of GP trainees is being overestimated.
These data should only include GP trainees in GP placements. In some areas with lead employers it looks rather like all GP trainees, including those in hospital posts, have been counted.
Class 4NI contributions?
Why no Crown Indemnity for primary care?
Well let's do the maths.
According to NHS Litigation Authority Annual Report here:
The total outstanding provisions for secondary care litigation in England are £27.8 billion
There are 58.1 million registered patients in England.
The provision for secondary care liabilities alone is therefore £479 per head for England.....more than the entire annual costs of running General Practice (BMA quotes something like £135 per patient per year.)
It may be disingenuous to compare total liabilities/provisions (with typical run off periods of many years, even decades) with the annual cost of our service, but it is illustrative of the sums involved.
As beds close, stays get shorter and work shifts towards primary care, so does risk. Risk does not stop at the secondary care provider organisation's front door.
Controlling indemnity liability is an existential risk for General Practice. Given the sums involved, the tight finances of the NHS, the increasing liabilities for PFI, the addiction of secondary care to expensive consultant workforce growth and the shift of risk; I suspect that NHS Litigation Authority would be loathe to extend crown indemnity cover to General Practice.
I hope I am wrong and that our negotiators will pull a magnificent rabbit out of the hat.