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CAMHS won't see you now

'We are beginning to see the fruits of the GP Forward View'

NHS England's primary care director gives an update on progress made on the second anniversary of the start of the five-year General Practice Forward View programme.

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When the General Practice Forward View (GPFV) was launched in April 2016, against the back drop of a decade of underinvestment in general practice, record low GP morale and an already unfolding recruitment crisis, our task was clear. This was to both support and transform the service, as even back then, almost nobody felt what was happening was sustainable. That is even clearer now.

However, in a period of austerity simply increasing general practice funding, in its existing form, was never on offer. What was on offer was more funding for a service, so it could start to rebuild, but also transform in a way that both fulfilled its potential and contributed to the wider sustainability of our NHS.

Frankly, we would not have secured the quantum of funding we did, culminating in an extra £2.4 billion a year for general practice services by 2020/21, had we not adopted this more transformative approach. I am pleased to report the funding trajectory for the GPFV remains on track, despite the many pressures on our NHS.

Twenty-four months in to this five-year programme, which some have described as ‘the biggest change management programme in the history of English general practice’, we are now beginning to see some of the fruits of this investment, and whilst I understand that not every practice is seeing the benefit of every one of the comprehensive package of initiatives yet, we remain clear that all practices should feel the benefit of all its elements by the end of the programme. I recognise this requires the profession to suspend its cynicism, but to give an example, it’s not long ago that if I’d have suggested to a room full of GPs that a state backed indemnity scheme was around the corner, I would have been met with disbelief.

As a working GP, I am also acutely aware of the challenges we still face

The face of general practice is gradually changing. In the last two years, examples include 800 estate and IT schemes completed, 2,100 practices benefiting from the resilience programme, 176 CCGs engaged in the Time for Care programme, over 5,000 trained care navigators, 2,100 trained staff in managing clinical correspondence, numerous digital schemes such as rolling out online consulting and Wi-Fi in practices, and more clinicians servicing 111 calls. There are over 3,900 more FTE other health professionals in practices than two years ago, including around 500 more FTE practice based clinical pharmacists, with over 580 more to follow soon.

Later this year we will also see the full roll out of access hubs to every part of the country, providing much needed appointment capacity for hard pressed practices. We will also start to position the general practice forward view initiatives, and other support, in a way that aligns with, and accelerates, the grassroots move towards working at scale, in the form of primary care networks. I hope this will help bring to life the impact of the GPFV initiatives in your neighbourhood, as I believe they represent a real opportunity to help build resilience within groups of practices, and broaden the range of professionals and services that will work within and alongside practices to help manage demand, as well as offer our patients an enriched version of primary care.

As we move through the gears of the GPFV we need to stay firmly fixed on our aim of improving patient experience, quality of care, sustainability of services, and crucially, developing ways to ensure a more fulfilling working day for all of us. As a working GP, I am also acutely aware of the challenges we still face. We are yet to see our workload significantly reduced by changes to the contract between CCGs and hospitals. And despite having more GPs in training than ever before, reinvigorating the induction and refresher and retention schemes, offering increased flexibility through GP Career Plus schemes and kicking off a major international recruitment campaign, GP recruitment and retention remains a significant problem for most practices. We all know there is much more to do before it starts to feel different. But I also remain convinced of two things. Firstly, we are fixing many of the fundamental issues facing our service, such as indemnity, and there are a steadily growing number of practices, that have actively engaged with the programme, that are starting to see the benefits.

Dr Arvind Madan is director of primary care and deputy medical director for NHS England

Readers' comments (12)

  • Dr Madan you are clearly living in a parallel universe. The reality for most General practice is quit different. While we have skill mixed we were already doing this before GPFV we have no choice but continue this as we cannot recruit GP's because of lack of supply and cannot retain them as the global market is more attractive. I have less GP sessions now than 10 years ago in my practice and a 25% reduction in income. My practice building is antiquated and operates at at least 90% occupancy for clinical rooms so i cannot grow the service even if i wanted to. There is no way i could or would borrow additional funds to develop my buildings and the money supposedly in place from NHSE has not made it our way. We are instead looking to reduce NHS services and develop additional income streams to stabilise the practice in the longer term until we can leave and take a reduced income in another sector, emigrate or retire. The GP Forward View is an absolute failure.

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  • Fruits? Only Practices with CCG and LMC officials are tasting fruits, the rest are going NUTS being bullied to join the FV bandwagon so LMC and CCG can both get the goading fee of £5 per patient promised by their masters.

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  • Seems he gets the issues and is starting to deal with some of them whilst accepting there is a long way to go.

    Remember this is on the back of years of decline and can't see many of the pulse commentators stepping up to take this on.

    Keep going mate!

    PS He's right on indemnity (assuming it gets sorted)

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  • The investment may have flowed out of NHS Engand, but it has not gone to General Practice. It may have gone to the companies whose lobbying secured the funding. Those handy management consultants who set up the schemes outlined in the 5yfv.

    Still as long as their shareholders are happy we are all happy as our pensions are invested with them... what... they aren't?

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  • GP solved. Get Prof Stephensons Resilience training and Dr Madan's resilience money.
    But, if don't want War and Resilience all your life, avoid this Hunt's Penance.

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  • Most of us have gone through at least four biggest changes in general practice in our careers and which each ove the service has deteriorated.Change fatigue has definitely set in.

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  • Cobblers

    The fruits of GPFV? Durian fruits then.

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  • No Arvind, we aren't.

    Estates - a mess that is going to take billions of pounds to fix because it hasn't been managed properly for decades.
    Workload - doubled in 15 years
    Resources - down 30% in real terms in the same time
    Pay - significantly less than comparable professions
    Terms and Conditions - significantly worse than comparable professions
    Burnout - significantly higher than comparable professions
    Workforce - collapsing, people leaving in greater numbers, fewer people joining medicine let alone general practice (look at the post-F2 dropout rate)
    Morale - historical lows
    Indemnity - some cost increases paid, a minor and transient sticking plaster that needs a proper, fundamental sort out.
    More money for more work was never the solution because this is not a sustainable baseline.
    101 different small pots of investment has just allowed NHSE regional teams (I'm looking at you, London and the Healthy London Partnership) and also CCGs to fritter huge sums away on pet projects, with minimal impact on general practice.

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  • Nice one Arvind.
    How many GP sessions do you do?

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  • The GPFV didn't stop me from resigning my paetnership and it didn't stop my partners resigning their contract 2 years later.

    And silly me! I thought it was the GPC fighting for a state backed indemnity scheme.

    If you want a totally salaried service, GPFV may make sense. It has done very little for struggling partnerships.

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