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GP appointment numbers to be cut by over a quarter under regional plans

NHS managers in one area of England are planning to reduce the number of GP appointments by over a quarter by sending more patients to other healthcare professionals.

The regional blueprint to ensure NHS services are sustainable by 2020/21 across Bristol, North Somerset and South Gloucestershire (BNSSG) says 27% of patients now consulting GPs will be treated by physiotherapists, nurses and pharmacists instead.

It also aims to reduce numbers of home visits, surgery visits and outpatient appointments by up to 15% by using home monitoring and remote consultation.

BNSSG's strategy forms part of its Sustainability and Transformation Plan (STP), which outlines how providers and commissioners will improve health care quality and financial stability as directed in the Government’s Five Year Forward View.

The news comes as STPs featured heavily in the news this week, including revelations of planned hospital closures and a BMA analysis finding areas require at least £9.5bn upfront cash injection if they are to be able to make healthcare provision sustainable.

The plan says that seven-day multi-disciplinary team working will be introduced across a primary care system based on ‘prevention, early intervention and self-care’, integrated primary and community care and acute care collaboration. Meanwhile, GPs will operate in ‘integrated clusters’.

The plan describes how demand for GP services in the region rose by 13% between 2008 and 2013/14, but the STP argues it can absorb a further predicted rise in demand for primary care of 12% by 2020/21 through its new strategy. The region is already piloting a system using multi-disciplinary teams to cut GP workload.

The plan says: '[We will] reduce the number of consultations conducted by GPs by up to 27% through diversion of work to more appropriate MDT members and non-clinical services.

'[We will] decrease the number of home visits, surgery visits and outpatient appointments by up to 15% through the use of home monitoring and remote consultation.'

But local GP leaders said the plan was unlikely to keep general practice sustainable against predicted dwindling GP numbers in the region.

Avon LMC chair Dr Mark Corcoran said: 'I have no idea where they get that 27% figure from. It has no basis in research and it feels like they have plucked it out of the air.

'It’s likely there will be a reduction in GPs in the area and so there will not be a reduction in workload for those who remain. We all know there is a crisis in recruitment and retention. In the South West 30% of partners vacancies are unfilled. It’s one thing talking about making reductions, and it’s another thing actually doing it.'

A spokesperson for the STP area said: 'The figures in the sustainability and transformation plan are estimates based on a range of information sources, from both local and national data. They provide a view of the scale of change we will need to achieve to arrive at a sustainable model of care across BNSSG.'

The area's 'do nothing’ deficit will be £305.5 million by March 2021, according to the STP. It has identified £138.9 million savings by this date, including a £11.6 million reduction to the cost of GP prescribing.

What are the sustainability and transformation plans proposing?

Pulse’s scrutiny of the 44 STPs have previously revealed how:

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Readers' comments (12)

  • Not sure how remote consultations reduces appointments - these are appointments (just in a different form to coming into the surgery), requiring the same time, a GP's experience and confidence with consulting over Skype or Facetime or whatever system NHSE consider best suited and reliance the computer system doesn't crash as is the norm.
    How about proper funding, make the job appealing again, encouraging juniors into GP because they want to do it, surely better than yet more expensive sticking plasters.

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  • Having done remote telephone and video consultation for many years I can honestly say that if you provide more space for consultations demand rises until you are just as busy as you were before, but now doing double the number of consultations that you were in the past. And you will still find people complaining because they can't get an appointment, even over the phone. The answer is to have a break on demand for access and unfortunately the only way seems to be linking activity to finance. Some form of copayment upfront is the only way.

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  • Why do the people in charge not seem to fundamentally understand the system? Just look to OOH if you want a model of how triage + risk averse systems cost and hit secondary care etc.
    The above comment is very interesting but doubt it will be listened to.

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  • A further significant drop is in the offing once we deprive smaller Practices from doing extended hours just because they can't avoid closing that one half day to catch their breath. For a Practice offering 2 extended hours per week that's about 10-12 slots per week and about 500-600 slots per year- and that many patients less will be seen courtesy our self back-thumping GPC/BMA and self-righteous Hunt. Thank you for the wonderful contract that has saved our four letters.

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  • Classic reverse target setting.
    Instead of setting a target to increase consultations, when you know there will be no money for this, set a target to decrease access and consultations, then pay less and magically hit the target in your plan as GPs leave!

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  • But don't forget: if you are worried in any way about anything at all then GO AND SEE YOUR GP.

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  • Doctor McDoctor Face

    50p bet says this will go t@ts up within a month

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  • Doctor Man; Ten Quid says it goes bang in a fortnight.

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  • How can 27% be an estimate? 20-30% could be an estimate but an exact figure demonstrates the absolute total stupidity of this. Anyway all NHS estimates, figures, predictions etc are politically motivated Orwellian half -truths. Like - err - 5000 new GPs.

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  • Have a look at this ( embedded in the article) :
    https://www.northsomersetccg.nhs.uk/media/medialibrary/2016/11/stp_appendix_b1-11-2016.pdf

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