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Must do better? NHS England graded on their support for general practice

Pulse grades NHS England two years after it announced its £2.4bn 'GP Forward View' support package

Practice resilience programme

What is it? 

A £40m fund designed to support practices on the brink of closure. 

What NHS England says

'Of the £40m GP Resilience Programme funding, £16m was spent in 2016/17 and we are on track to spend the committed funding for the programme’s remaining years (up to 2020). In 2016/17 over 2,100 practices benefited from resilience funding.'

Pulse's analysis: While NHS England's figures are all very well, Pulse is sadly still reporting on a myriad of practice closures, meaning the help was too little, too late for many practices. 

GRADE C-

Estates and Technology Transformation Fund

What is it?

A £900m fund announced by former chancellor George Osborne originally designed to improve practice premises.

What NHS England says

'We are on track to deliver the original planned investment. As at 28 February 2018, 866 schemes have been completed, and there are a further 972 active schemes (427 in due diligence, 170 pre project, and 375 in delivery).'

Pulse's analysis: Although we are happily surprised to read the hundreds of schemes are now completed, the rollout of this fund has been marred by delays. In one town, the long-term viability of general practice has been thrown into doubt after promised funding was withdrawn.

GRADE D

Time for Care

What is it?

A £30m fund for commissioners to help implement measures to reduce GPs' workload.

What NHS England says

'In 2016/17 £8m of the £30m fund was spent... There are 94 schemes covering 176 CCGs... Nearly 1,100 GPs, nurses and practice managers have been engaged as at 31 January 2018. 100% of participants in the core programme rate the input as very good or excellent.'

Pulse's analysis: The programme does appear to be on track, however not a lot of evidence of its impact has - understandably - filtered through yet.

GRADE B

Indemnity scheme

What is it?

A £60m cash injection to cover increases in indemnity and a commitment to resolve the problems of increasing costs in the long term.

What NHS England says

The full allocation was made in 2017/18 and practices have been paid their share accordingly.

Pulse's analysis: The fact remains that GPs are having to fork out thousands towards indemnity cover each year, while hospital colleagues do not. The jury is still out on the benefits of the state-covered indemnity scheme, which will start in April 2019.

GRADE C

Transformational support fund

What was it?

A fund worth £171m – or £3 per patient – to help practices ‘transform’. It was left to CCGs to interpret this.

What NHS England says

‘The first year’s investment in transformational support directly by CCGs is in 2017/18... We fully expect CCGs to invest at least this amount over the two years of the fund.’

Pulse’s analysis: As Pulse has reported, funding pressures have forced several CCGs to postpone their investment - worth £3 per patient to practices - until the very last minute, meaning many practices have yet to see a penny.

GRADE D-

E-consultation support

What is it?

A £45m scheme to help practices adopt e-consultation services.

What NHS England says

The £45m fund is split over three years. 2017/18 is the first year of the fund and we are on track to spend the allocation. In early adopter practices, 40-60% of consultations are resolved without the patient needing to attend in person.’

Pulse’s analysis: GPs are still eagerly awaiting research to prove that moving to e-consultations does indeed save practice time. To date, research has suggested they save time nor money; and that they could even lead to extra work.

GRADE C

Seven-day services

What is it?

Health secretary Jeremy Hunt’s pet project. The GP Forward View committed £500m to support practices in offering Saturday and Sunday routine appointments.

What NHS England says

The 2017/18 mandate target to deliver access to enhanced GP services, including evening and weekend access, to a total of 40% of the population has been exceeded, with more than 50% of the registered population benefitting from extended access to general practice services including evening and weekend appointments.'

Pulse’s analysis: There is no doubt that this is being rolled out at speed. But the issue lies with the evidence base and whether it actually does help GPs, or patient care. The majority of GPs would say no, so until the Government can prove its value, it’s not going to get a good grade.

GRADE E

GP retainer scheme

What is it?

A scheme designed to keep experienced GPs in the profession through an enhanced financial incentives package for the GPs themselves and their practices.

What NHS England says

'The latest statistics published in February show that there are 254 retained GPs being supported overall up to 31 December 2017. This includes 54 GPs now being supported through the new GP retention scheme, exceeding the indicative target of 50 GPs.'

Pulse’s analysis: The scheme itself is performing well. But, unfortunately, it is a drop in the ocean. The truth remains that GPs are continuing to retire at a faster rate than they are coming into the NHS.

GRADE B-

GP mental health service

What is it?

A £19.5m service run by former RCGP chair Professor Clare Gerada that allows GPs to access free, confidential mental health support.

What NHS England says

‘GP Health Services have been established and will continue to funded be as planned and set out in the GPFV. Since Jan 2017 we have seen 1,271 GPs access the service including; 259 existing patients transferred from other services; 1,012 new patients following launch of the service.'

Pulse’s analysis: Although we don't yet have any data on the recovery rate of GPs who go through the programme, this scheme gets A for effort. Finally, there is somewhere for struggling GPs to turn for confidential, GP-specific advice and support. Now, if only we can tackle the root causes of GP burnout…

GRADE A 

Pharmacists in general practice

What is it?

A £112m scheme to get 1,500 pharmacists into GP practices.

What NHS England says

‘As at 31 December 2017, NHS Digital report 1,009 clinical pharmacists (or 658 FTE) were actively working in general practice, an increase of 734 (490 FTE) since September 2015.'

Pulse’s analysis: The scheme has made progress but many GPs told Pulse about a lack of information marring the programme at a local level.

GRADE B

Schemes for support staff

What are they?

A £45m fund to train clerical staff, £6m fund for practice manager development and a £15m fund to train nurses

What NHS England says

Clerical staff scheme: ‘£6m was spent in 2016/17 and funding has continued to be spent in line with the GPFV commitment through 2017/18 and is expected to spend in full.’

Practice manager scheme: ‘£1m was spent in 2016/17 and funding has continued to be spent in line with the GPFV commitment through 2017/18 and is expected to spend in full.’

Practice nurse training scheme: ‘In July 2017, NHS England published a 10-point plan which brings together key actions to meet general practice workforce challenges under the themes of “recruit, retain, return”.'

Pulse’s analysis: The schemes to train other members of the practice team are welcome, but unfortunately the number of nurses and non-clinical staff in primary care actually fell in the year leading up to September 2017.

GRADE C

Mental health therapists

What is it?

A scheme to place 3,000 mental health therapists ‘in general practice’.

What NHS England says

‘We’re continuing to deliver on our commitment for 3,000 practice-based mental health therapists, as the NHS integrates mental and physical care. We are already seeing progress in many areas of the country with 594 extra therapists in December 2017, which is in line with GPFV commitment.'

Pulse’s analysis: There has been a bit of trickery from the Government on this pledge. But GPs were disappointed to learn last year that practices will not be funded to employ the therapists directly.

GRADE D

Secondary care workload dump

What it is

A commitment to stop hospitals from dumping work on GPs, specifically involving sending DNA patients back to the practice to be re-referred.

What NHS England says

'We have worked with partners across the system to develop national guidance clarifying responsibilities for prescribing between primary and secondary care. This will ensure GPs only take on appropriate responsibilities for prescribing from secondary care. We are identifying examples of good practice where primary and secondary care are working well together.'

Pulse’s analysis: While NHS England acknowledges that the hospital contract changes has not had sufficient impact, it is welcome to see a working group has been set up to address the problem.

GRADE C-

Overall comments

NHS England has been pretty successful in channelling funding where they said it would go, with a couple of notable exceptions - like the £900m premises fund. 

But GP numbers continue to fall, practices continue to close and workload keeps increasing. On top of this, the strings attached to much of this funding make it hardly worthwhile for stretched practices. 

This may not be NHS England's fault - there are certainly political directives here. But until GPs' working lives start improving, NHS England will be dangerously close to a fail.  

GRADE C-

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