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Gold, incentives and meh

Come up with a plan to make general practice 'sustainable', NHS tells all areas

NHS bosses have told all areas of England to come up with a plan for the ‘sustainability and quality’ of general practice next year.

Planning guidance issued to all CCGs, local authorities and NHS trusts says that this must include addressing both ’workforce and workload issues’ in general practice in 2016/17.

The move comes after the Department of Health announced last week that general practice will receive 4% funding increases every year until 2021.

The planning guidance comes from the ’Five Year Forward View’ bodies – NHS England, NHS Improvement, CQC, NICE, Health Education England and Public Health England.

It gives nine ‘must-dos’ for every area next year, including CCGs ’tackling unwarranted variation in demand’; and getting ‘back on track’ with access standards in A&E, referral to treatment; cancer waiting times and cancer one-year survival rates.

But for GPs, the most important development is that every area of England will have to form a plan on how to ensure general practice is sustainable during 2016/17.

The document says: ’Develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues.’

This comes after Pulse has been campaigning to ‘Stop Practice Closures’ highlighting that general practice in many areas is becoming unsustainable.

An LMC conference in January will also look at emergency measures on how to make general practice sustainable, with some pushing for a vote on industrial action.

The new guidance also sets out the next stages for implementing the new models of care under the Five Year Forward View.

NHS England area teams, CCGs, trusts and local authorities have to propose new geographical ‘local health and care areas’ covering all of England by October 2016.

They will have to write a ’Sustainability and Transformation Plan (STP) to submit to NHS England by June 2016 setting out how to implement the NHS Five Year Forward View and the Government mandate to NHS England locally by 2021.

The mandate, unveiled last week, saw the Government tell NHS England that half of the country should be covered by new models of general practice by the end of Parliament.

NHS England said that from 2017/18, these STPs will become ‘the single application and approval process’ to access any of the £560bn transformation funding announced in the Government’s Spending Review settlement.

A new CCG Assessment Framework, or ‘scorecard’, will also be introduced, on which NHS England is planning to consult in January, but which will include data on local clinical outcomes.

The document said: ’We are asking every health and care system to come together, to create its own ambitious local blueprint for accelerating its implementation of the Forward View.’

It added that areas that come up with the clearest and most credible STPs will ‘secure the earliest additional funding’.

NHS England chief executive Simon Stevens said: ’This guidance sets out the next steps to make the vision set out in the Five Year Forward View a reality. A new approach to how local NHS leaders plan to meet health needs across whole areas will sit alongside the new Sustainability and Transformation Fund established as part of our £560bn funding plan for the NHS.

’Together they will help to ensure the NHS has solid financial foundations from next year, and to transform how care is delivered up to 2021.’

Readers' comments (40)

  • A good start would be to stop treating us like shit.
    Maybe also stop bullying us via your "media chums"
    Thirdly give Hunt the heave ho for Christmas!

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  • Another Dictat from NHS England. They have messed everything up and could not have planned the implosion of the NHS better if they had actually tried to and now a mindless stupid Dictat to the actual hard workers who are the survivors.... sort the mess out !!!!

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  • Sorry but an order from The Ivory Tower is going to help how? Yet more meaningless twaddle, supported by stupid action plans, written by folk who haven't got a clue. Why would anyone want to access 'transformation' funding? It's relentless transformation that's caused the problem. Stop promising patients the earth for a budget of thruppence hapenny.

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  • They are trying to make working in the NHS like living in the planned Soviet economies of the 1930s with central incompetent diktat allied to inadequate resourcing. Eventually we will be so brow beaten we will be gladly herded into the
    market economies represented by Virgin Health and all these horrid little private companies set up by quisling GPs. We recently advertised for a new partner and received two applications -30 years ago there would have been a 100. Until that reality has been sorted out all manner of "Five year forward view"s (how soviet is that by the way!) are no more than footnotes in the history of the death of the NHS.

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  • Vinci Ho

    ’Together they will help to ensure the NHS has solid financial foundations from next year, and to transform how care is delivered up to 2021'

    Seriously ?
    It is sad if one has to say something even oneself does not believe. Paid a decent salary by the emperor , bear all worries for the emperor .
    So from next year , if any more GP surgery is closed , NHSE and the CCG should be 'punished'?

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  • How about "pay us properly then leave us alone"?

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  • This is simply a ploy to blame local CCGs for the collapse, whilst Hunt and Simon Stevens and Steve Field continue the destruction at national level.

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  • General practice has already imploded and if you don't have plans to retire or emigrate, then work within the new realities.

    All this crying over spilt milk is undignified.

    Practice losing money? = Close the damn thing and go salaried, it's the employees market at the moment and a GP post with one year of experience can easily earn £9.5k per session with NHS Pension and MDU fees thrown in.

    Ironically, this makes our salaried GP's slightly better paid for their time than senior partners, but partners have other perks in the equation.

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  • The commissars continue the collectivisation process.WELL DONE!

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  • I have an answer:
    £££ via taxes
    OR
    £££ via optional co payments

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  • NHS general practice is DEAD

    So they throw a few more pennies at the cadaver but it wont resurrect it...its over

    The attitude of the patients and politicians will never change and even another 50-100 grand wouldnt make me want to come back to the UK....

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  • More inspections and appraisals coming your way soon. Cue a load more stupid QI schemes dreamt up by prescribing advisers and managers who have never set foot in a practice. Watch out for 'learning events' and extraordinary meetings taking the workers away from the coal face and making the day after doubly toxic. Plenty more jobs for 'service transformation managers', 'senior and junior communications managers' and all the other plethora of apparatchiks. Oh, and think you're going to get a pension at the end of this any more? Think again. When there are no NHS GPs to threaten pi**poor strike action(not writing housing letters for a day etc.) then HMGov will have no reason to pay you all the money they have been looking after for you.

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  • How about its my job to sort out sick people. Could I not just stick to that?

    If they are listening
    Government run indemnity scheme. Like BC
    Fixed liability for errors eg 10k for one eye. No solicitors, like New Zealand
    Streamline cqc or pay us locum time to do it.
    Get actual real help from NHS England if practice in difficulty eg helping recruitment.
    Make a ton more GPs.
    Reinstate a pension age where I'll realistically be able to do the job safely.
    Help us rather than bash us.

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  • The prophecy has come true. The government washed their hands of having to provide this by law. Now they can just write dictats for "others" to full-fill. When it all goes belly up, "it was the GP's fault". Everyone saw it coming.
    The answer is pay them and they will come. Let gp's do their job and stop interfering/micromanaging/over regulating/underfunding/multiple jepordy and the GMC and the job will be worth doing.

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  • how about we ban all cardigans and all politician from any decision making that is none of their business? Why are we allowing plumbers to mess with electricity ? We indeed are a blind blob waiting to rot away.

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  • Here is my plan if NHS England wants to make General practice sustainable
    1) STOP DICTATING AND START LISTENING
    2) Tell public that OTC medicines will not be prescribed by GP under any condition ( NHS England can make it available free of cost at local pharmacy if they want ) - this will reduce unnecessary appointment and real sick people will have an easier access.
    3) No sicknotes from GP - They can access it from dedicated professional
    4) Fix up charge for each GP appointment Eg £30. NHS England can make it means tested so poorer people pay less but state contribute more for those people.
    5) Charge all DNA GP & Hospital appointment
    6) Make defence union fee reasonable.
    DO THIS & GPS WILL STOP LEAVING THIS COUNTRY

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  • It is all rather reminiscent of Blackadder in the trenches - Lions led by Donkeys!!

    OK chaps over the top - if anyone can come up with a plan we'll do that for a while.....

    DOH a great forward thinking & planning organisation - not!

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  • The parternship model is the only way that the NHS can survive without going bust. Like OOH was, they do not reaslise how much work is done.
    1) make the 4% unconditional
    2) retire at 60 for front line workers eg A+E/GP.
    3) cover MDU fees.
    With something like this the docs will come back to GP. Unfortunatley I doubt it will happen.

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  • and I want to save the service that treats its staff appallingly because?

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  • 1. Fee for service. That will mean that the harder you work the more you get paid. Right now the harder you work, the less you get paid, based on an average income per GP/Patient encounter. If incomes increase, reduce the interference of government in the ways that GPs sort out their retirement.
    2. Open access to any GP you want to see. That will mean that the best GPs get the rewards for their competence and hard work and the less competent or hard-working will learn that they can improve their income and ability by hard work. ALL doctors are clever these days, so they can all improve if there are incentives to do so. No such incentives exist at the moment.
    3. Give GPs the freedom to charge privately if they see fit. When patients get a receipt they should be able to get some or all of that money back from the NHS. In other words,integrate the public and private sectors and suddenly there will be a surge in availability of health professionals in both the private and the public sectors. There need be no such thing as a two-tier system.
    4. Trust GPs to be more in charge of the investigations and management of their patients. Let them take patients to a higher level if they feel comfortable in a particular area of medicine. One GP might have an expertise in skin disease but be less competent in psychiatry. Or vice-versa. Recognise we cannot be 'all things to all men', encourage diversity and discourage conformity.
    5. Recognise that the best advocates for patients are the GPs themselves, not some jumped -up bureaucrat, RCGP presidents (politically to the left of the mainstream), all GP CQC 'professors', government meddlers, self-appointed guardians of 'patient safety' a specious and overused concept anyway - we all know that they feather their own nests at the expense of real quality.
    5. Listen to the experiences of the 'returners' from systems elsewhere, the ones who have seen how general practice can be done when the leash has been loosened and GPs become the true 'generalists'. GPs know more general medicine than most specialists other than in their chosen, narrow, fields, and we certainly know more than the general physicians of 40 years ago. Trouble is, in the UK GPs are highly trained and have nowhere to use these skills. One of the biggest problems we have had over the years in Australia is teaching UK GPs how to use investigations properly, teach them procedural skills and get them to think independently - to 're-skill'. The most admired skill a GP has in the UK is how to 'refer'. The skill most admired in other countries is how to 'manage'. In the UK those two words are synonymous. In Canada, Australia and NZ they are very different.
    6. Use GPs wisely, reward us with trust and a proper income and you will see a massive return of the new GPs to the joys of general practice in the UK, an outcome that would good for the patients and the doctors themselves. Too late for me, but it could save the NHS for future generations.

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  • Took Early Retirement

    QUite right John Elder- you were in the Army, weren't you? Over to you mate!
    (I was only in the Scouts and only made it to Assistant Patrol Leader at that!)

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  • If you look at the 9 "must dos" for 2016/17, they all seem to be as unachievable as the demand to sort out GP sustainability, workforce and workload.
    https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf or
    http://tinyurl.com/opedro6
    We're all supposed to be sharing Good Ideas: perhaps NHSE could be asked - persistently - for *its* "Good Ideas" (if any) about how this could be achieved at a local level?
    In particular, I'd like to hear about no 2: "Return the system to aggregate financial balance.This includes econdary care providers delivering efficiency savings through actively engaging with the Lord Carter provider productivity work programme and complying with the maximum total
    agency spend and hourly rates set out by NHS Improvement. CCGs will dditionally be expected to deliver savings by tackling unwarranted variation in demand through implementing the RightCare programme in every locality"
    If this is this - https://www.england.nhs.uk/ourwork/pe/sdm/nat-prog/rightcare/ - it sounds as though setting it up will be resource intensive.. which won't help getting back into financial balance!

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  • But why would you want to save a poor service that according to the Chief Inspector [ sort of Japp ] has failed. The Chief Inspector is ashamed to be a GP.
    So am I. But for a different reason. That I have been such a fool, seeing 90% of NHS consultations for 7% of the budget at 5 pound profit per consult and being criticized,and scorned by patients,politicians,papers,peers,
    professors, the other professions, CQC and GMC.

    I wish I could tell everyone, please, please do not be a complete fool like I have been.
    Do NOT become a GP. 50% are frankly depressed, 50% of the rest anxious and the rest just worried.
    Please, please Do something else.

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  • I am not sure that GPs are better than Physicians of 40 years ago. I knew Barrters and Moschcowitz and pseudo -pseudo hypoparathyroidism and Simmond Sheehan and so forth 40 years ago.
    GPs are good, sure, and know about a lot and about things like ADHD, but better than Physicians ? Different and admired for that.
    Hang on, have you spoken to Prof Fields recently? He might think differently.

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  • I use the word Physician in the old sense of the word. Steve Fields sadly has a point. WE relinquished our role years ago. I did the LMCC (Canadian qualification) in 1980. Passed it easily. The consultant rheumatologist sitting next to me failed it three times. The consultant I met the other day didn't even know what bisoprolol was for. Believe me, we know more...

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  • allow retirement at 60.

    solve the GP recruitment crisis.

    or continue the push for retirement at 71 and I'll wish NHS England, DoH and HMG the best of luck with that.

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  • Fu*k off!- all areas tell 'NHS bosses'.

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  • I thought that was the job of the NHS bosses.
    Can intellectual property be claimed?

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  • An example of gross mismanagement, lack of transparency, vanishing of funding given by Councils for Practices passed on from Developers to meet additional patient population needs, not paying sickness reimbursements to GPs for over a year, paying reality/deprivation payments on Exeter statements to only chosen Practices, Federations formed by LMC top brass. All this in just one region of Kent and Medway speaks volumes of the scale of total shambles the whole of NHS is in.
    To beat this, premises funding modelled and offered in a hideous manner so only the chosen ones can avail.
    Now they want a plan? Maybe, let's start by sacking the whole top brass in NHS, liquidating KPCA and NHSE and begin to look for an alternate solution. Get in NHS Fraud Agency to look into all the issues raised above and then ensure these things do not happen again.
    Merry Christmas and a time for contemplation- for those wronged and for the wrong-doers.

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  • Captain England of NHS Titanic is asking the rats on the ship not to disembark yet...while he is preparing his own get away!

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  • More money, less over regulation, no revalidation, no gmc, no cqc, no or very low indemnity fees

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  • GP unpopular? No wonder. Who wants to work under a dictatorship of ignorant politicians - what do they know about running medical practice? If a NHS is to survive, let the profession say what is needed and inform the government what is required financially
    Retired GP

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  • In spite of seeing 90% of NHS consults on 7% of the NHS budget, in spite of a 50% fall in pay per item over 10 years, we are vilified by all.
    We are a greedy, corner shop, failing profession.
    It is time to fold up GP land in this current form.
    It must be dismantled and I hope it self destructs.
    If there is a cheaper better alternative, Allow Mr Hunt and the various papers, patients, professors and the politicians to find it.
    We should go. It was time a long time ago.
    And only GPC keeps it going to our detriment.

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  • Retiring on 1st April 2016 aged 56. Good luck

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  • It seems that the Government (bunch of self-serving, entitled, arrogant and conceited D’heads) does not wish to govern. Sure it is full of people with theories and opinions but they are clearly “ bad ideas” people who are incapable of delivering anything. Their whole ethos is to concoct impossible plans and then to delegate, privatise and outsource the responsibility for delivering them. Then when the impossible proves to be such, the government points the finger rather than accepting that its ideas were seriously flawed to start with.
    Mr Hunt I don’t know how stupid you think the public is but I sense that they realise you are trying to dupe them. Time to go and maybe run a sweatshop in China – the economy you admire so much.

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  • This is surely an admission of failure by the central planners!

    Er we couldn't stop general practice failing so um er you come up with some plan!

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  • @Anonymous | GP Partner28 Dec 2015 6:04pm

    "Retiring on 1st April 2016 aged 56. Good luck"

    You and many others. In April the NHS will be is serious trouble.

    It will make a great watch but poor patients.

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  • How about get rid of Jeremy and some of those ridiculously overpaid nhs manager beaurucrats with their big fat bonus checks for doing nothing other than making nhs front line staff employment totally miserable.

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  • This comment has been moderated.

  • Ok so .. Get rid of NHS bosses Who get paid for asking people to come up with a plan.
    Ditto CCGs was never going to work .. , only one way traffic, politbureau to proles (NHS workers)
    Let us get on with our job and teach the next gerpneration what professionalism is ( not tick boxing for Tories )

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  • There are great gps out there and I am not a fan of bad practices.

    We have a great service and the alternatives are awful.
    A few of my patients are beating the 2 wk wait by emergency attendances.. Word gets around ..
    Costs will skyrocket and all the gate keeping will be lost.
    Can the NHS survive

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