One year on: what progress has the GP Forward View achieved?
Pulse gives NHS England an end-of-year report
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Comments: NHS England has made a slow start but promises of investing an additional £2.4bn a year by 2020/21 into general practice are being implemented. This year’s GP contract builds on last year’s, with some £0.5bn extra funding in total.
What to work on next year: NHS England has been distracted by the turmoil in hospital budgets, with acute trusts bailed out to the tune of £1.8bn last year. It must focus on getting the promised resources more quickly to GP practices to improve its grade next year, particularly through CCGs and the £900m committed for ‘capital investment’.
Scrapping the QOF
Comments: This year was the second in which no changes were made to the QOF, to the relief of many practices. But NHS England promised in the GP Forward View that it would look into removing the QOF completely to reduce the bureaucracy faced by practices. A review of the framework has begun, but this coming year will be crucial.
What to work on next year: GPs should be encouraged that there seems to be a real desire to remove the QOF. But the final year grade will depend on what NHS England comes up with to replace it.
Cutting CQC red tape
Comments: Real progress has been made on this over the past year, with the CQC promising that from this month ‘good’ and ‘outstanding’ practices will only be inspected once every five years.
What to work on next year: To achieve a higher grade, more work must be done to ensure that CQC inspections are a positive experience for practices that require improvement. Better still, scrap the whole regime and replace it with peer review and support.
Mental health support for GPs
Comments: NHS England has finally started paying attention to this subject after a four-year Pulse campaign highlighting the lack of help for GPs facing burnout and fatigue. A nationwide counselling service** was launched in January this year and within six weeks, more than 1,000 GPs had signed up.
What to work on next year: Better promotion of the service and more work on preventing GPs getting burnt out in the first place would merit an A*.
**The NHS GP Health Service is a confidential national self-referral service; GPs can call 0300 0303 300, or email email@example.com. There is more information online at gphealth.nhs.uk
Comments: A strong start to the year on this sadly fizzled out. NHS England appeared to stand up to hospital trusts by changing their contract to stop them unnecessarily re-referring patients to GPs. However, a Pulse investigation shows that not a single sanction has been imposed on trusts, despite CCGs receiving thousands of complaints from GPs.
What to work on next year: Give the contract some teeth, so hospitals will have to take notice. Otherwise, this will be a fail for NHS England.
Boosting GP numbers
Grade – too early to say
Comments: There has been limited success from attempts to get 5,000 additional doctors working in general practice by 2020, with a small increase in the number of trainees recruited in 2016. But there has not been enough focus on retaining existing staff and GP numbers actually fell overall last year.
What to work on next year: Instead of small-scale schemes to increase GP recruitment, NHS England should bring in some major measures to make general practice a more attractive profession overall – such as a significant injection of funding into the core contract or the scrapping of CQC inspections.
New practice staff
Comments: The aim to introduce more in-practice pharmacists seems to be going well, with 491 brought in since 2015, while the number of practice nurses has increased. However, new physician associates are still two years away from coming on stream and mental health workers won’t be up and running for a while. Meanwhile, there’s no sign yet of the money for training practice managers or receptionists.
What to work on next year: Start getting these new workers into practices so GPs can see tangible benefits.
Supporting vulnerable practices
Comments: NHS England has not lived up to its promise on this vital subject. Despite promising £16m in rescue funding – to add to £10m promised the previous year – it has lagged behind.
Barely any of this money was provided at the start of the year, with practices that sought help not being given the support they requested. In the time-honoured tradition of schoolkids everywhere, though, local managers seemed to cram when coming up to deadline, rushing through significant amounts of money in the past few months.
What to work on next year: At least another £8m is due next year and NHS England needs to ensure this reaches the front line quickly to prevent more practices closing.