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GPs buried under trusts' workload dump

Reaction to the GP partnership review's final report

All the reaction to the report from the Government's official review into making GP partnership more attractive

Dr Richard Vautrey, BMA GP committee chair:

The partnership model is the backbone of general practice and is what has given it its strength and resilience, providing the foundation to the NHS for the last 70 years. Thus, as has been noted time and time again, if general practice fails, the whole health service crumbles around it.

This important report, and the support offered to it both by the secretary of state and the chief executive of NHS England, provides clear backing at the highest level to the partnership model as the best way of delivering what most patients want – and that is good quality continuity of care delivered by a locally-based team, embedded within their community, who they know and trust.

The model, which gives practices the autonomy and independence to innovate while building quality relationships with people in their local community and being able to advocate on their behalf, is why both patients and the CQC continue to rate general practice so highly.

It is vital then, that the model is given greater support to ensure its survival.

The report rightly notes the increasing pressures placed on GP partners and the growing risks and liability they carry, and it is therefore imperative that the Government takes these seriously, from backing changes to indemnity to coming forward with tangible proposals to reducing the risks inherent in owning and leasing practice premises.

One key area – the significance of which cannot be underestimated - is the current workforce crisis. The number of full-time GP partners in England continues to fall as they struggle with workload pressures, and without enough doctors both the sustainability of the partnership model and the quality of care offered to patients are in jeopardy.

In his recommendations, Dr Watson proposes a number of solutions to the problems in recruitment and retention, and as with the other areas of his report, we will be keen to work with the Government and policymakers to take these forward.

The recommendations to address the long-term perception about general practice are particularly important to implement, enabling more doctors to experience general practice as part of training and giving more GPs the opportunity to learn more about what being a partner involves.

We should be under no illusions, however. As is often the case with the most complex of conditions, there is no miracle cure or panacea within this report. Dr Watson’s recommendations will take time to implement and decisive action and long-term commitment from ministers and health bosses, building on pledges already made in the NHS long-term plan, is required if we are to see the meaningful change both doctors and their patients desire, and a partnership model fit for generations to come.

Professor Helen Stokes-Lampard, chair of the RCGP:

The partnership model of general practice allows GPs to innovate in the best interests of our patients, it puts us at the centre of our communities, and it provides great value for money for the NHS.

This review is a vote of confidence in GP partnerships and shows that they are an important and viable option for GPs at all stages of their careers, now and in the future – and it addresses some of the key issues as to why we are currently finding it more difficult to recruit GP partners.

We particularly welcome the focus on reducing unnecessary workload in general practice and increasing both the GP workforce, and the wider practice team.

Workload in general practice has escalated in recent years both in terms of volume and complexity, and we are now making over a million patient consultations every day, yet we are doing this with a smaller share of the NHS budget than we had a decade ago, and fewer GPs than we did two years ago.

Our members consistently tell us about the red tape they have to deal with daily that gets in the way of what matters – direct patient care. So, the report’s recommendations to reduce the bureaucracy involved with CQC inspections, appraisal and revalidation and GDPR compliance - and to simplify and streamline the communication we have with colleagues across the NHS, must all be explored and implemented.

Ultimately, no model of general practice will be sustainable without sufficient numbers of GPs and our teams, so the recommendations to implement fellowships for newly qualified GPs, extend and enhance the GP retention scheme, and ensure the GP training budget reflects the true cost of delivering placements in general practice, are all also welcome – as is the recommendation to ensure the status of general practice by formally recognising it as a specialty.

This report is optimistic and pragmatic – and has benefitted from being GP-led and having such rich GP input – but implementing the recommendations effectively will depend on having the funding and workforce to do so and hope the forthcoming workforce strategy will address this.

We urgently need the promises made in NHS England’s GP Forward View, for £2.5bn extra a year for general practice and 5,000 more GPs – and a guarantee that our profession will receive a significant share of the funding outlined for primary and community care in the NHS long term plan – delivered in full and as a matter of urgency.

We eagerly await the response of the secretary of state and Simon Stevens to the review and detail about how they plan to take forward these recommendations.

MDDUS chief executive Chris Kenny:

We welcome this review into the partnership model and we are glad it has highlighted the daily and ongoing pressures and demands that our GP members face. We believe that the partnership model should be supported in a way it can continue to be a success and removes the unnecessary demands placed upon it. 

However, the recently published NHS Long Term Plan states that a state-backed indemnity scheme (SBIS) will be ‘cost neutral’ so GPs need absolute certainty on how any scheme will be paid for – in 2019/20 and future years. That’s a key issue for today’s partners in particular – but also those who aspire to partnership in future.

Neither SBIS nor this review addresses the cost drivers causing the rise in indemnity costs which can only be tackled through legal reform. 

GPs in England and Wales will still need the protection of MDDUS as the SBIS does not cover complaints, involvement in coroners’ cases, GMC hearings and other matters relating to professional regulation and non-NHS work.

Finally, MDDUS fully supports initiatives that promote GP partnerships as this model provides continuity and helps reduce clinical risk.

Beccy Baird, senior fellow at The King’s Fund:

These proposals are a welcome attempt to revitalise the partnership model which has proved very successful over many years. The review deals with some of the technicalities that dissuade GPs’ from becoming partners, such as indemnity and risk. However, tackling unsustainable increases in the volume and intensity of GPs’ workloads will also be critical to ensuring the partnership model remains viable. A credible national workforce strategy which addresses gaps in the numbers and skills mix of health care staff needed to support general practice is also desperately needed.

The NHS long-term plan places general practice at the heart of improvements to the health service. If that ambition is to be met, then general practice should be provided with support and training in leadership, management and organisational development, and it will need to be central to integrated system plans.

 

 

Readers' comments (7)

  • Prof HSL is correct, the ‘the partnership model of GP.....provides great value for money for the NHS’. Exploring the rest of her comments was unfruitful but I remain pragmatic and optimistic and hope to remain sufficiently sustainable to implement going forward.

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  • Unsustainable increase in volume and intensity.
    More than a million consultations with fewer GPs.
    All agree, but how mathematically ?
    What is the definition of sustainable and acceptable volume ? What is the number of GPs needed ? How many contacts per day/ week/year.
    If we do not define normal or sustainable, then merely saying something is abnormal/ unsustainable cannot have a contextual meaning.

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  • Tantalus

    It is relatively easy to get piecemeal work at £80 an hour with no responsibilities, stress or red tape. Being a partner has all of the above for about half that hourly rate.
    It’s not difficult to see why portfolio and locum careers are more popular.
    It also explains the exodus to Australia, New Zealand and Canada.

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  • David Banner

    Partnership means more and more work for less and less pay, with the added bonus of unlimited liability bankruptcy when all your partners skidaddle. It is doomed.

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  • Took Early Retirement

    It's all too late. I have to say the collapse is taking longer than I thought; more like watching bits crumble off a glacier than a sudden earthquake all over the country, but it is still happening.

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  • Nice to have a formal review, but it seemed decidedly bland (toothless) in its analysis, as if political care was an aim. It missed some important pieces of the puzzle therefor. ANd that's then leaving policymakers unbriefed on key areas that need addressing: Very light on retention I thought and very vague about recruitment. Patient demand not addressed at all.

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  • Unless practices are adequately funded nothing will work.
    practice payments should foresee and cover a reasonable rate of income for a Practice per 2000 patient a minimum of:
    Salaries ;
    - For one wte GP
    - 0.66 wte Nurse
    - 1 wte Manager
    - 1.5 wte Receptionists
    - 0.5 wte HCA

    I am not touching on premises which is another issue.
    At present, the situation is that some Practices have 4000 patients and if they had 2 GPs at a 100 k full time and a full time Nurse, they would not be able to afford a full time Manager or more than 2 Receptionists or pay their premises bills.
    On the other hand, there are Practices, who have 4000 patients and employ 2 full time partners, one salaried and are advertising for a 4th part time GP.
    How does that work?????

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