What will 2013 bring for GPs?
After the maelstrom of 2013, Pulse looks into its crystal ball, and with the help from some leading GPs, defines likely themes for the coming year.
1) A huge ramp up of QOF workload
It is a safe bet that the Government’s will impose the most wide-ranging QOF changes since the framework was introduced from April.
The changes will see funding for the organisational domain removed, a raft of new work introduced, upper thresholds hiked to reflect the performance of the top 25% of practices – including to 100% in some cases – and a change in the way QOF payments are calculated.
The changes have been described as ‘unworkable’ by the GPC, which has suggested that practices evaluate carefully whether the additional workload is worth pursuing.
Dr Peter Swinyard, chair of the Family Doctors Association, said that the changes will be ‘extremely difficult for GPs to cope with.’
He said: ‘Money is being taken away from the QOF organisation domain for things we have previously been paid for doing, and we need the money. Tightening of targets and incorporation of new QOF work will be difficult to cope with at a time when we’re at burnout. The wheels really are squeaking.’
He added that the threshold hikes are ‘worrying’ and could mean practices decide not to try to gain the points for some indicators: ‘If you set a threshold too high people will say “It’s not worth trying for it”. They’ll say “We can get our blood pressures down to 140/90 but we can get them down to 120/90. Patients won’t take enough drugs because it makes them fall over.”’
2) Practices battling with online records and new IT systems
One of new health secretary’s four priorities is to bring ‘the technological revolution to the NHS’ and GP practices are at the forefront of his plans.
After initially laying out plans in their Information Strategy - a ten year framework on how to improve access to healthcare information - the DH have proposed a new DES worth £3,600 of former QOF funding per practice - to come into effect from next year to implement the changes.
It will require practices to offer patients the ability to book appointments, order prescriptions and receive some test results online. From 2014/15, GPs will also have to make further test results available online, provide secure electronic communication within the practice and offer online access to medical records.
It also plans to introduce a DES incentivising ‘remote monitoring’ of patients from April, that will mark the start of the rollout of the Government’s cherished ‘3million lives’ telehealth initiative.
Dr Paul Cundy, chair of the GPC’s IT subcommittee predicted GPs would experience a ‘tsunami of irrelevant electronic communications’ that would prove difficult for practices to cope with.
He said: ‘GPs will receive communications from the sharply elbowed worried-well e-Twitterati at the first sign of a snivel, any ache or minimal disturbance of their physiognomy.
‘With any luck we may end up doubling the worldwide internet traffic,’ he quipped.
Dr Cundy also said that DH plans to expand patient choice of providers on Choose and Book and rollout telehealth were unlikely to have much of an impact.
‘Telehealth will pass - as most fashions - into the distant memory.’ he said.
3) Screening for signs of dementia
Dementia care is top priority at the Department of Health, after the Prime Minister issued his ‘challenge on dementia’ this year. The DH is under pressure to show that it is making progress on increasing dementia diagnosis rates and reducing antipsychotic prescribing in this group of patients.
Progress has been patchy so far, with plans to roll out a dementia diagnosis app being branded as ‘pie in the sky’ by the GPC, and antipsychotic prescribing rates coming down in dementia but not for a stubborn minority.
This is likely to change in 2013, with the Government proposing to fund a new dementia case-finding DES using cash released by retiring QOF organisational indicators.
GPs will have to assess all patients over 75 years, those aged over 60 years with CVD, stroke, peripheral vascular disease and diabetes, all patients with learning disabilities and long term neurological conditions such as Parkinson’s disease for the early signs of dementia.
The move has kick started a petition against the plans. Proposer Dr John Cosgrove, a GP in Birmingham, said the DES was not evidence-based and risked distracting GPs from other work.
He said: ‘Asking all patients over 75 if they are having problems with their memory is a screening test, however GPs are asked to do it. It needs to be properly evaluated.
‘I’m concerned about how it will affect the spread of resources in terms of GP time, memory clinics, and competition between patients with dementia for resources. The problem is going to grow and snowball over subsequent years.’
‘We need a political solution on how to meet the needs of our elderly population and this is just a distraction. Instead of focusing on diagnosis, we should be offering on the basis of need.’
4) GPs take on commissioning
Four months’ time will mark the beginning of the great CCG experiment in the NHS. Led by GPs, these groups will be responsible for spending the NHS’s £65bn commissioning budget.
Balanced precariously on their heads are the whole NHS reorganisation project, and the success of the biggest efficiency drive in the history of the NHS. They have a lot to prove.
Before then, the vast majority of them will have to be authorised, providing they can get past the complex web of requirements from the NHS Commissioning Board. With three-quarters of the first-wave being hit with conditions on their authorisation, this will be no mean task.
They also have to implement, sometimes unpopular, reorganisations of services and in the midst of private providers vying for a slice of the NHS cake. All this while negotiating a potential conflict of interest minefield - with one in five of their boards with financial interests in private healthcare providers.
Commissioning tsar Dr James Kingsland, a GP in Wallasey, warned CCGs have to tackle the ‘them and us’ feeling that is developing amongst grassroots GPs.
He said: ‘The priority has to be the engagement of the wider clinical community. CCGs must realise that the constituent practices are its members – not just the governing body.
‘I am still hearing too many practices saying “us and them” rather than the inclusive “we”. If CCGs get that right, everything else will follow; if they get that wrong, they’ll fall into the same trap as the PCTs.’
Dr Charles Alessi, NAPC chair, said CCGs should concentrate on addressing health inequalities.
He said: ‘We cannot have situations where parts of the CCG have significantly better outcomes than other parts of the CCG without action being taken.’
5) Continued squeeze on GP take-home pay
GPs have endured several years of pay freezes, and rising expenses, but 2013 will be the year where practice finances will be hit harder than ever.
GPs face additional expenses from revalidation and CQC, rising pension contributions, cuts to local enhanced services, increasing work imposed on them from secondary care and working harder than ever, just to stand still, under the contract for 2013/14.
Dr Ivan Camphor, medical secretary of Mid Mersey LMC, said: ‘It is just terrible and cannot be sustained in its present form.
‘The GPs I am speaking to are not prepared to engage in commissioning anymore. GPs certainly don’t want to engage with CQC registration.
‘Where are we going to pay for all this, how will we pay with a £30,000 pay cut, with £1,700 loss from MPIG, with CQC registration [fees]. The list goes on and on and on.’
‘How are we going to do this? With what resources? And people want us to be open on Saturdays and Sundays. We may as well give up. It is not the end of general practice, it is the end of the NHS.’
GPC deputy chair Dr Richard Vautrey agreed that further ‘efficiency savings’ were untenable in primary care.
He said: ‘The expectation from The Treasury is that general practice has to achieve 4% efficiency savings in the same way as hospitals are doing, without any real understanding of the impact that has on practices.
‘Practices have already delivered far greater efficiency savings than 4% by coping with the increasing shift of work from secondary care, by coping with the increase in consultation rates for our patients.’