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Simon Stevens: The bulk of this package is about supporting existing practices

The chief executive of NHS England and Dr Arvind Madan, NHS England director of primary care, speak with Pulse news editor Jaimie Kaffash 


Practices are struggling right now. What measures will immediately help those that are on the brink?

Dr Arvind Madan: We announced the work around the struggling practices scheme, which has been implemented for 2016-17. We’re also launching the resilience team, with the commendation of both the GPC and the RCGP, and bespoke measures around supporting practices that are not quite in that struggling range.

One of the other measures we’re also taking around immediate relief to workload pressures is the standard contract changes.

But actually also measures around reducing some of the regulation in the system, some of the reviews of areas such as mandatory training, and increased use of various technology.

Will these actually be implemented in the next couple of months?

AM: Yes, some of them are active from now, in terms of the standard contract measures that mean that the interface between primary and secondary care is materially changed.

I know, for example, in my own surgery I was going through mail and actually thinking as I was working my way through it that ‘That will change, that will change, that will change’. That’s the kind of thing that will happen immediately.

Obviously some of the other measures will take a little longer to introduce, but we’re going to be working quite closely with the RCGP and the GPC on ensuring that is only going to be meaningful for GPs if they start feeling the change in the consulting room. We’re very conscious of that.

How many of these measures are actually new? A lot of them seem to be repackaged, for example, the recruitment issues within the 10-point plan last year.

Simon Stevens - online

Simon Stevens - online

Simon Stevens, chief executive, NHS England: On the money, this is obviously new – the 14% real terms increase plus the rescue package of £500 million plus extra that CCGs are going to be asked to put in - that’s all new.

Then on the specifics, on indemnity we have got a detailed overview of what the options for that look like, why some of the reflex answers might not actually be the right answers.

The clear/key we are committing to is that there is absolutely no reason why GPs should be on the hook for rising indemnity costs, when hospital doctors aren’t. We need a solution that deals with that.

On CQC, 87% of the practices so far that have been through an inspection - and all of them will have been by the end of the year –  are good or outstanding. The five yearly CQC review and the commitment to cover off any of the extra costs associated with that - that is new.

In terms of workforce, the big expansions in the clinical pharmacy programme, given that we were oversubscribed dramatically on that - that’s new. The 3,000 therapists and psychologists that will be embedded in general practice: we talked about those in the mental health taskforce. We, at that point, did not predict that they would be embedded as a resource for GPs. We are making that commitment here tomorrow.

In terms of the 5,000 GP quote - we want to get as many extra GPs as we can, go all guns blazing. The bulk of it will rely on HEE being able to deliver on their commitments around trainees, and the increase in the round one acceptance application rate on to the vocational training scheme this year is hopefully an early sign that, with the support of the college and the GPC, we are turning a corner there.

But, we’re also saying that we’ve got a lot of streamlining to do on return to practice, and also international recruitment.

How much of this will be dependent on GPs becoming new models of care? How much will be dependent on them offering seven-day services, for example?

SS: The bulk of this package is about supporting existing practices doing what existing GPs came into medicine to do, and have grown increasingly frustrated about, the pressures on them, and the relative lack of resources.

To deliver on this package does not require all of those things to come into play, but the reality is that a number of practices - over half - are forming into federations or looser practice groupings or super-partnerships across the country, and as they do that, what they’ve been saying to us is: ‘We would like to be able to have greater influence over the way community nursing services are organised, over the way other parts of the so-called ’out-of-hospital’ funding streams work.

So the voluntary contract that GPs in Manchester and Birmingham and parts of London and parts of Nottinghamshire are working on, is about giving GPs that extra influence over all of those different funding streams.

But it’s voluntary, and we’re certainly not expecting that the bulk of GPs will be choosing to do that. We just want to put it on the table for those that do.



How do you ensure that this funding does go directly to GPs? How much of it is dependent, for example, on CCGs stumping up the money?

SS: For next year, of the total, basically I think only £171m of the £2.4bn extra is expected to come from extra CCG spending, but we will need to nudge CCGs in that direction.

And that’s one of the reasons why it makes so much sense for GP governing bodies to really be using their ability to influence CCG decision making in that direction.

AM: I think as you said, there is a substantial investment, and actually there is an expectation that if we are going to be successful in bringing care close to home in any meaningful way the CCGs will be re-engineering the care they commission in their areas.

General practice and primary care services and community services are clearly a more cost effective environment if the care can be provided safely. So I think the ambition is to go beyond the central funding that practices and general practice services will receive, and actually that will be supplemented by CCGs taking a proactive approach in that area.


You do mention something about moving people from being locums to being salaried or in partnership. Is there anything there to specifically incentivise the partnership model, as opposed to being in a salaried role?

AM: The measures are designed to make being part of a general practice team - a regular team - more appealing again. I think probably there has been a shift in balance as workload pressures and patient expectations have increased, that have meant that the life of a jobbing GP is actually pretty difficult.

So I think it’s a bigger piece around how we make that more manageable, that will hopefully entice people who have found it easier to cope as a locum for a period back into the regular workforce, so that we can provide better patient care and more continuity.

 Simon Stevens is chief executive of NHS England. Dr Arvind Madan is NHS England director of primary care and a GP in South London

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Readers' comments (10)

  • Operation CanKick 2016 a resounding success.

    Collapse of primary care delayed by 18 months.

    Then what, Si?

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  • Certainly there are some positives here, and it is nice to know that the Gov is finally listening. I am concerned about the 'extra money that will be invested by CCG's'. This clearly is not new money - in fact it doesn't exist. It needs to be taken from current secondary care spending - that's called QIPP, and all CCGs are struggling to make further savings in that area.

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  • Dr Madan, Please look into the HSCIC/Exeter payment systems. It is not possible that when you add 26 patients your payments increase by 13 patients but when your list falls by 8 patients your paytment is reduced for 58.
    There is something grossly wrong and this needs urgent investigation. I am not sure why the LMCs/NHSE and Exeter won't look into it - Maybe that's to give the government leeway to manipulate and destroy Practices which are inconvenient, but this is a grey area that someone needs to look into.
    One of my colleagues in Gillingham actually gave up after 4 years of trying to get an explanation why his weighted list was progressively diminishing - is that what the aim is of this lack of transparency.
    Do one good thing and look into this please.

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  • I'd say the bulk of the package is paper and the rest is ink.

    Sorry, I meant best thing since the 1960s

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  • Harley Thespaniel

    Not a pay rise then?

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  • Thought the Cray's were sliced bread.....

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  • 9.33am is right. This is plain fraud. Gps should be paid for the patients they have. If they increase by 22 patients they should be paid for 22 patients. If they decrease by 22 patients then they should have 22 patient less payment.
    To pay them less this is not right and needs to be addressed urgently otherwise I do not see why every gp should not collect all the money that has been stolen from them by the authorities. It is illegal to steal money in this way as it makes them common criminals.

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  • The Headline is all good news - but how this is to be implemented at the frontline - i.e. practice level seems a bit obscure: clarification would be useful.
    e.g. SS:For next year, of the total, basically I think only £171m of the £2.4bn extra is expected to come from extra CCG spending.
    Haven't CCGs already signed off their 2016/17 budgets (which are already inadequate with more in deficit every year)? If the funding coming to general practice is partly dependent of CCGs revising their budgets to accomodate the diversion, can anyone see it happening this year?
    Funding additional staff is welcome - but doesn't address the lack of funding for existing staff - or solve the problem of space in most surgeries. (NASA is trying out an inflatable room: maybe practices could do a trial for earth-bound use?)
    As usual - lots of projects - which no doubt will need Business Plans, competetive bids (in triplicate) against tight deadlines, and initiation beforee any funding is received-if it ever is.
    Could someone ask SS about immediate rescue plans? After all, if there was believable rescue in sight, practices about to be forced into closure might be persuaded to stay on a few more months...

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  • This is all a combination of recycled initiatives announced by fanfare and a bit of indirect funding in line with the central NHSE plan which is unlikely to ever reach a general practice directly. What was needed was a substantial injection into core funding for practices. Sadly this has not happened and it's clear NHSE still does not trust practices to make the right decisions to invest in primary care. No direct injection of funds means no increase to partner or salaried gp pay so no shift back from locum land. The pay restraint for nursing and administration staff will need to continue perpetuating the exodus to pastures greener. There is nothing here about retaining the 50% of GPS over 50 who will retire in the next 3 years. All this in the background of partner pay gradually falling to a level below employed gp staff and the instability caused by PMS reviews and MPIG "realignment". Why on earth would a GMS or PMS practices continue? Most ccgs are in the red mainly due to tariff rises last year on the background of static ccg funding. A ccgs main duty is financial balance often at the expense of primary care as trusts will be bailed out under any circumstances. However primary care is expendable in its current form. The comments by Arvind Madan says it all really when he states that ccgs need to "re engineer" primary care and "the ambition is to go beyond central funding". Traditional general practice is going to die in a few years. The federated model is the future albeit only a short term one. The final direction will be organisations such as HMOs either as MCPs or PACs which are too big to fail and will be bailed out when they exceed their capped budgets as by that time they will be monopoly providers. I doubt these organisations will work within the current unviable budgetary restraints. So the solution is, if you want to and you are able to, get your federations developed and make yourself too big to fail and you may have a chance. If you don't, then other health management organisations will be there to pick off the pieces.As a gp working in such an organisation, expect to have no power to make changes except for a select "entrepreneurial connected" few. It is such a shame that a patient centred working primary care model which has been the envy of the world has been deliberately defunded to the point of collapse with the aim of replacing it with a more costly (and hence profitable) poorer alternative which will financially benefit a select few. Bother the RCGP and the BMA/ GPC are complicit in this proposed future, either through incompetence or intentionally and responsible for the secondary deprofessionalisation of the medical profession in the UK.

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  • This comment has been moderated

  • Ha ha ha, good joke! Was this meant to be a comic article like throught the K hole?
    Or was could it be named as one through the a** hole???

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