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NHS England to carry out major 'value for money' review of GP premises reimbursement

NHS England has set out new proposals to reform general practice, including a major ‘value for money’ review of rent reimbursement and plans to address the recruitment and retention crisis.

Managers also say they will commission a new study to look at how to free up time in primary care and ‘move towards’ CCGs jointly commissioning GP practices with local area teams, as first reported by Pulse almost a year ago.

The recommendations are included an ‘emerging findings’ document from NHS England’s Call to Action consultation published today, which aims to reduce variation in general practice, give patients more responsive and ‘person-centred’ care and promote better health.

However, reacting to the publication, the GPC accused NHS England for ignoring the real plights facing GPs, rehashing old policies and trying to mask cost cutting as patient benefits.

Ideas included in the document include encouraging GPs to work ‘at scale’, encouraging new providers of primary care to enter the market and a major review of the current system of GP premises reimbursement.

The document said: ‘In order to support new solutions we will … work with the Government to review the current system of general practice
premises reimbursement to identify opportunities for improving value for money and promoting more innovative use of estates.’

It also reveals that NHS England will produce a ‘detailed plan’ later on in the year to tackle the current crisis in recruitment and retention of GPs and launch a new ‘strategic framework for commissioning primary care’ that will include ideas on how CCGs can commission jointly with area teams - to be published in the autumn.

How does NHS England want to reform general practice?

  • Looking at a joint, collaborative approach to commissioning general practice services, with flexibilities for area teams/CCGs to design local alternatives to national contract arrangements, and other forms of contracting in June 2014
  • Reviewing the current system of general practice premises reimbursement to identify opportunities for improving value for money
  • Supporting practices in working at greater scale (through federations or networks) to facilitate a more effective and cost-efficient use of estates’;
  • Preparing a detailed plan by summer of 2014 on NHS England’s role in ‘improving GP recruitment and retention’
  • Publishing guidance on practice mergers and ‘new market entry’ in July 2014
  • Publishing a strategic framework for commissioning primary care services’ in September 2014
  • Launching a ‘freeing up time in general practice’ study – ‘identifying how we can go further in freeing up clinical time to provide more proactive, person-centred care and improve access’ in April 2015.

Source: Improving General Practice, A Call to Action. Phase 1 report, NHS England

The document said: ‘Developing more integrated services will depend ultimately on the leadership and cultures of the different provider organisations involved - and we are already seeing great examples of general practice starting to come together with community health services, social care and specialist services to do this.

‘To support these changes, however, we need to ensure that we commission services in a holistic way, based on the needs of a given locality. To do this, NHS England intends to move towards joint arrangements with CCGs for commissioning general practice services.’

The document adds: ‘To support this approach, we are expressing primary care allocations at a CCG population level. This will enable CCGs and NHS England to look at the resources available to spend on general practice alongside resources for hospital and community services in each locality.’

The document said: ‘Our area teams are already working with CCGs to reflect the direction of travel set out here in local strategies for primary care services, as described in our NHS planning guidance for 2014/15, Everyone Counts.’

‘But we know there is more work to do to build the national foundations for sustainable primary care, delivered at scale. We want to continue our discussions with key stakeholders on our emerging views. This period of engagement will run from March to June 2014. We intend to publish the resulting strategic framework for commissioning primary care in the autumn of 2014, covering not just general practice but wider primary care services including dental services, community pharmacy and eye health services.’

GPC deputy chair Dr Richard Vautrey commented: ‘This is a very disappointing response to an extensive consultation. It is largely a rehash of all the current DH and NHS England policies and contract agreements with little if anything new. There is no real sense that they have listened to the widespread concern about the real issues facing general practice - unsustainable workload pressures, the falling proportion of NHS funding being used for general practice, the recruitment and retention crisis and the major problems with premises which prevent practices developing their services.’

‘Instead of offering hope to practices and patients it just restates - and tries to spin them as benefits - cutting MPIG, taking funding away from PMS and using the £5 per head of CCG money that is already committed.’

He added: ‘The bottom line is general practice cannot survive on 7.42% of NHS funding and GPC called on NHS England to commit to a year on year increase. This mirrors the current RCGP campaign. This is fundamental to the future sustainability of the excellent general practice we now offer. Until NHS England commit to that we will continue to let our patients down.’

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Readers' comments (22)

  • Most of this is management waffle,unless you are prepared to reverse the huge shift in funding that has left general practice for other area of the NHS it means is doctors,nurses and ancillary staff that are essential to treat people not buildings or management systems,we need to attract young british doctors into primary care and that means improving terms and conditions of employment,this government and NHS England has a pathological hatred of general practice just look at their DDRB submission which is nothing short of wishful thinking,this only works if money leads secondary care,and that won't happen

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  • don't care any more-retirement date set, pension sorted. 1 positive idea which nhs england/government will be too gutless to mention-stop time wasters withurtis and sore throats etc attending and also penalise dnas and access would be sorted

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  • This is likely to mean ceasing reimbursements to small practices and amalgamting practices into largery surgeries - read between teh lines!

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  • This is to screw money out of all practices by one sides own perspective and agenda - despite the long term agreements and long term business/financial commitments of the practices
    - by "re-interpreting" the rules they tried to get a 6 figure sum from us despite legal advice they were in the wrong but pushing it. We settled for a 5 figure sum but less than the legal fees would have been to contest it.
    BMA needs to stop this NOW - some hope!

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  • This is a step towards stopping rent. I have said for over a year this would be the next target and many partners laughed at me ......... unfortunately, this is coming and I'm starting to look for an exit stratergy from partnership.

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  • No problem. You stop the rent I close the shop. My plans to convert the surgery into two semi-bungalows for Buy To Let have been there for the past 10 years.

    COI Retired already.

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  • Anonymous | 11 March 2014 2:44pm

    This is not going to happen, not because of anything we as GP's are doing but because several corporates have built and own GP centres and have done so on the basis of guaranteed notional rent.

    If you're a small practice less then 3 FTE's then you may be vulnerable as many of the rules, CQC will encourage federation which if you're small will mean you'll be swallowed up by the largest practice in the area.

    There is a clear attack on us but when CG and her like are part of the attack we will struggle. Ultimately the target is the converted semi which is found up and down the country. These guys should start putting in residential tenants and getting relevant building licences for this.

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  • Shouldn't someone do a major value for money review on NHS england

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  • Somebody turn out the lights....I've left the building! Retirement plans looming large on the horizon! Way less stress and start living MY life, and not dance to NHSE agendas any more! What a sorry waste of skills, intellect and vocation...well done the DoH !

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  • Vinci Ho

    Only tells you one thing-
    The War on Bullying continues........
    For those in GPC and RCGP, somebody wants to burn the NHS flag by destroying the gatekeeper first. What are you going to ? What are you going to do? Show mercy to your enemy???

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  • 2.20pm, very well said. If primary care was able to spend the time with those patients that need our skills, the NHS would be in a better position. Sore throats of half an hour, the demand for free paracetamol on prescription, the chronic sick note malingerers, DNAs, those that are late for appts, all should be blocked from wasting GP time, charged for attendance. Until some threshold is on place, primary care will continue tobe inundated with triviality, stay overwhelmed and remain an unsatisfactory option for doctors!

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  • I suspect in 2 years I will be the only GP left.

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  • Just look at the hatred behind the comments left on this article... never mind the lies it is full of. why in the world should I or any one of us waste our time and effort to care for these thankless 'haters'?

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  • Anonymous | 12 March 2014 11:14am

    I wish I hadn't looked at the DM article and comments. Nothing less then expected from our Press, the comments were largely the type you would where's that Job advert for Alberta!

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  • I, like many of my generation, are planning early retirement because we cannot take this any more. I met up with a very good GP of only 4 years standing yesterday who is planning a change of career! I also note that most contributors, myself included, have opted to remain anonymous on this issue. If this is not an indication of the fear of bullying and intimidation I don't know what is.

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  • Anonymous always 12:29! Make a name for yourself and this NHS will punish you. Whistleblow don't make me laugh.

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  • @ anonymous 11.14

    Perhaps an opinion/perspective held by more of the population!

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  • The whole objective here is clearly to pave the way for the private sector to move in to primary care.

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  • Will the last GP turn out the lights. General Practice is dead in the water if NHSE continues to wring the final few drops from the sponge of General Practice.

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  • Be aware of scare stories and then releasing a review which is not as bad as the 'leaked' story suggets.

    Fairly standard negotiation tactic unfortunately

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  • They clearly want us to federate & fill all those new builds so that we are ameanable to take over by private providers.

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  • "pro active person centred care with improved access" sounds like a smaller practice to me. They are going the wrong way if they actually care about these noble sentiments.

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