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GPs go forth

How will the Forward View affect general practice?

Dr Arvind Madan, NHS England’s Director of Primary Care, explains

After a decade of relative underinvestment, I do understand the current frustration among fellow GPs. This is why I took on my role at NHS England. But I also believe the General Practice Forward View (GPFV) gives general practice a real fighting chance of a better future, as long as we work together to see it through.

How can struggling practices access emergency funding immediately?

Schemes are being developed in each area to identify struggling practices and offer them support that would be most useful. Around 800 practices nationally have already been contacted to make this offer known to them. In addition to this, the GPFV includes a further £40m for the National Resilience Programme, of which £16m is for 2016/17. This will be designed with the GPC and RCGP support. I understand that there is more to be done, but this will be of some help to those that are hardest hit by the current pressures on general practice.

What difference will GPs see in their practice workload immediately?

I am acutely aware that the real test of progress is whether we can see a steady reduction in pressures we face day-to-day in our consult rooms and surgeries. An example of action that should have impact soon is the legal changes made to the new national standard contract between CCGs and hospitals, and community providers. For example, this requires a hospital to manage outpatient DNAs, provide timely (standardised) discharge summaries, notify patients of their results, start treatments, provide sufficient medication and make any community referrals required. This will mean practices need to inform their CCG to take action. We will also set up a working group to monitor progress on this and address any further issues raised.

There will also be support for streamlining practice processes such as uptake of Patient Online for appointment booking, repeat prescribing and viewing records, as well as support for e-referrals, transfer of records, the electronic prescribing service and putting access for Summary Care Records in to all community pharmacies by March 2017, so less patients attend the surgery with medication queries.

The GPFV sends a signal to CCGs that they must support practices with their workload, and many of the more immediate solutions require local leaders to take action. This is already happening in some areas with CCGs developing models of protected learning events, resilience schemes, recruitment initiatives, receptionist navigation training, medical assistants training to manage correspondence, enhanced self-care, local minor ailment schemes and social prescribing schemes. GP access fund areas are already seeing the benefit of additional local appointment capacity within their neighborhoods.

The ambition is that, eventually, every practice will have access to all the initiatives in the GPFV, including working alongside a broader range of skilled professionals to support our every-day work, and local services for our patients to access that help us manage demand within our own practices.

How will GPs access mental health support?

We will be going out to procurement in June for the new service, which will be available to all GPs across the whole of England. The service is expected to be fully up and running by December. GPs will be able to access this through self-referral, but also through occupational health or on the recommendation of their own GP.

How will GP practices access a pharmacist?

In addition to the £31m already committed in the initial programme, detailed plans are being drawn up to accelerate and expand the existing clinical pharmacist scheme, which provides free training and subsidised funding over three years. This represents an additional £112 million of investment and the opportunity will be made available to all practices, in groupings of approximately one WTE pharmacist for practices covering 30,000 patients. Some of the pharmacist’s impact may be seen in areas such as streamlining prescription handling for practices, which occupies many hours of staff time. Different areas are using this funding in various ways; some practices are employing the pharmacist directly, and others are contracting companies to supply them, and manage their indemnity and employment issues directly.

How will GP practices recruit a mental health worker or physician associate? 

This year will see a growth in training of mental health professionals, with increasing numbers coming in to practices and neighborhood services each year. This will culminate in an additional 3,000 new mental health colleagues supporting practices by 2020/21.

Health Education England is training a large number of physician associates and the ambition is that 1,000 are employed in practices by 2020. You would employ them as you would any member of staff. My own experience is they are highly motivated and skilled individuals who operate well as part of a team, as long as the practice ensures they see the right cohort of patients, and have the right support systems around them.

How will the new hospital rules impact GP workload?

The new NHS standard contract now requires hospitals to manage outpatient DNAs, provide timely (standardised) discharge summaries, notify patients of results, start treatments, provide sufficient medication and make any community referral required. So, although it will take time and ensuring your CCG takes action, it should reduce workload. Let your CCG know if you are having any issues.

Will GPs have to start offering online consultations?

We know that we need to address demand, and we also know many patients are keen to use online services. Adding tools such as self-help content and symptom checkers from NHS Choices to the practice website can safely help patients with minor self-limiting illnesses to mange their own health, and reduce demand for appointments. It will be for each practice to decide if they think this, alongside other offers like online consultations, meet their patients’ needs.

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Readers' comments (11)

  • None of the above is going to help with the daily pressures on the GP appointment system,so access will remain the real problem.We need funding to enable us to employ more Drs-that is the bottom line.The rest of this hot air will soon get blown away.

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  • What a useless article.

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  • We don't want to take our begging bowls to CCGS to bid for someone who takes twice the time of a GP to see a patient and still needs supervision. We want more money in our global sum to make the job attractive again. Young doctors aren't stupid- they don't want to work for £30 an hour taking on limitless liability.

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  • If we get our noses to the grindstone and shoulders to the wheel by all pulling together we will see the light at the end of the tunnel - that's enough bullshit ed.

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  • My daily life has not changed and I cannot see anything in the plan that is going to help. Still getting numerous letters from secondary care. Start medication, refer here there and every where. Today single letter requesting referral to 3 different community services, prescribe, check urine and arrange bloods

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  • I don't see any real money going into partners pockets. Indemnity for overseeing pharmacists/physicians assistants and other noctors will be more money lost from our own pockets. Do people not understand liabilities and the need for someone to pay for it in our ever litigious world that is overseen by the over zealous cqc,GMC and NHSE, the patient safety and doctor health ignoring organistions?

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  • Vinci Ho

    (1) The inexplicable phenomenon is in fact this GP forward view should have been announced by the Secretary of State NOT the chief executive of NHSE , simply because the latter was never elected in a general election . And to answer all these questions about the logistics which inevitably involves how to spend this presumably new money , one would expect announcement as well as reassurance from the Treasury. I am sorry you have to represent NHSE to face the public instead and it obviously begs the question of where the hell is the Secretary of State representing the government elected by people . This is political ethics and is undeniable . Interestingly , the education secretary had to 'bravely' face the public to announce full academisation on her own.
    (2) In a time when there is a historically poor relationship between the government and the medical profession, more needs to be said and done by the real power holders to restore trust and repair damaged relationship before one can move on with any 'new plan'. This is yet to be achieved.
    (3) The use of various jargons and rhetorics(models of protected learning events, resilience schemes, recruitment initiatives, receptionist navigation training, medical assistants training to manage correspondence, enhanced self-care, local minor ailment schemes and social prescribing schemes etc ) is fine in summarising intentions but yet to convince people real solutions in every day life are to happen in local practices in the frontline.

    It is about what one believes but also more importantly about trust in those exercising authority to actually deliver solutions.....

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  • Little substance

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  • Do the people who wrote this plan honestly think we haven't thought of it all already? My practice has employed a pharmacist to run minor illness clinics and a team of triage nurses to support the GPs for years. We already offer booked telephone appointments and have a skilled team of administrators managing 1000 letters a week so the GPs only see the stuff they need to. We always take the trouble to tell the CCG when the local hospital tries it on and know how to say "no". We are already well organised, modern and forward thinking and we train and develop our staff. We achieve top results in QoF and make use of IT in ways that most other organisations can only dream of. Despite all this the patients want more, partners drawings fell again last year, morale is in the gutter and we can't recruit. All I can say to this magnificent plans is "been there, done that, got the T-shirt".

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  • Yes let's reward failure, that always works. Some fail through no fault of their own. Others fail because they are incompetent and greedy.

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