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GPs go forth

GP practices in one area offered £35m extra a year to work 'at scale'

Practices across mid- and south Essex will receive an extra £35m a year in funding in exchange for overhauling the way they work.

The ‘sustainability and transformation plan’ (STP) for general practice in the area says it intends to spend £30m between now and 2020/21 on reorganising general practice to 'work together in localities to enable the benefits of operating at scale to be realised'.

Their report also set out plans to recruit 120 additional GPs to the area, in order to mitigate an expected wave of retirements and an increase in demand as the population increases.

The five local CCGs, which have developed the plan with input from the LMC, said this comes as GPs are currently working at ‘unsafe’ levels, with demand for GP appointments currently outstripping capacity ‘by 20,000 a week’.

They said the reorganisation will result in practices working in hubs covering 30-50,000 patients each, in line with the recommendations in the GP Forward View, and a 'move from a service that is GP-delivered to one that is GP-led', similar to the changes being made under the new GP contract in Scotland. 

The STP said the current model, whereby 'almost all care' is 'delivered by a GP', is going to 'be difficult, if not impossible, to sustain'. It plans to roll out new 'methods of triage and care navigation' to manage demand on GPs with the help of multi-disciplinary support teams, and introduce 'widespread use of digital technology'.

The report said: 'We estimate that fully implementing this strategy will require additional recurrent investment of £35m a year by 2020/21, as a result of significantly increased investment in workforce, estate and digital solutions.'

And it added that the 'anticipated additional cost of introducing the new model' is 'approximately £30m by 2020/21'.

The plan said:

  • 'morale in general practice in our STP is at a very low level’, with 'demand for [GP] appointments outstripping the available capacity by 20,000 a week’ based on a data analysis carried out earlier in the year, with the assumption that 'a significant proportion' of these patients attend A&E instead
  • 'if we carry on as we are by 2020/21 in a "worse case" scenario the gap between the demand for appointments and the capacity available could have widened from 20,000 to over 60,000'
  • 'we need to recruit another 120 GPs, as well as more clinical practitioners, physiotherapists, mental health and social care professionals and a range of other support staff', to be shared across NHS Basildon and Brentwood CCG, NHS Castle Point and Rochford CCG, NHS Mid Essex CCG, NHS Southend CCG and NHS Thurrock CCG, and be brought in through a combination of international recruitment, golden hellos and the new medical school at Anglia Ruskin University
  • its 'main objective' was to 'move towards safe working levels for GPs' of 'approximately 23 patients a day', in line with the recommendations that were published by the BMA earlier this year, as 'most GPs' are currently 'seeing well over 30 patients per working day'.

Essex LMC chief executive Dr Brian Balmer said: ‘We know that we have a large number of older GPs in mid- and south Essex and are facing exceptionally high levels of retirement in the years to come.

‘A key part of our proposal is to improve the work/life balance for GPs in mid- and south Essex and provide greater opportunities to support their training and development. This will help us retain vital clinical staff and attract new recruits.

‘We want to demonstrate that working as a GP in Essex is an attractive proposition and as such we are developing an exciting and positive plan for the future for our primary care services.’

The STP also said it envisages 'that a range of new ways of seeing patients would develop, including telephone consultations, increased use of e-consult systems and remote monitoring'.

NHS Southend CCG chair Dr José Garcia Lobera, who led on developing the proposals, said: ‘Whilst we appreciate many patients consider their local GP to be a first port of call for an illness or condition, it is often not a GP that a patient needs to see.

'By expanding our primary care workforce to embrace a much broader range of expertise we can ensure patients are seen more quickly by the right team so that GPs can focus on patients with the greatest need.’

Researchers have called for more evidence to be gathered about the clinical and financial impacts of new large-scale general practice models being pursued by NHS England.

Readers' comments (11)

  • An STP proposing and accepting change for GPs must be helped and to do it in a sensible manner....why cant they all be like this?

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  • National Hopeless Service

    I am so glad I am at the end of my career. Just not looking forward to get old and ill when primary care will be a fractured mess. Why O why cannot we just get rid of the dross that is preventing partnerships flourish again.

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  • well done! amazing what you guys are looking to achieve! you have great managers coming into the area to make this happen

    good luck!

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  • Would you want to he registered at a practice with 30 000 patients ?
    In resource poor countries primary health care is delivered by non-Drs. This model proposes a Gp lead rather than Gp delivered service. Clever spin as essentially it is proposing a system in which a patients chance of seeing a Dr become more and more remote.
    Will it be cheaper , probably not as the general public generally want to see a Dr and if all else fails achieve this by presenting at A&E . And also generally not, as the chances of actually seeing someone who knows your history is unlikely . That is even before considering where the 120 GPs will come from , presumably not home grown . Gp does benefit from scale . small scale,for primary consultations by highly qualified Drs in practices where patients can get an appointment in a timely fashion with a Gp who can follow them up appropriately .
    Patient demand now significantly outstrips GP supply and so a dilution of the system is inevitable .To spin this as a positive is deceptive .It is a shame the 35M couldn't be found years ago when it could have supported high quality healthcare instead of buying high quality veneer for a system descending to failure.

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  • this will be fascinating to watch. It seems to be a dismantling of traditional General practice with a personal GP and the rise of salaried community geriatricians (because the GPs will mainly be seeing elderly complex cases) while taking the rap for any mistakes made by the team of 'noctors' working under them. who would want to work like that??? I shall be fiercely defending traditional ways of working which the young GPs seem to value as we have had no problems recruiting......

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  • I agree with bewildered.
    This path leads to dumbing down and poorer care and service for patients. Just look at CAMHS which is a Consultant ‘led’ service. You have to be half dead or killing others to see the actual psychiatrist by which time significant mortality and morbidity has already occurred.

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  • Took Early Retirement

    recruit 120 additional GPs to the area,

    Like, er... will these come from the extra 5000 that would be recruited by 2020? No indication of what inducements will be on offer to get 120 extra GPs. One presumes, a magic wand.

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  • Did I read in the Pulse recently about a study which shows that seeing the same doctor ( ie continuity of care ) leads to less use of hospital resources ?
    So how will seeing multiple non doctors in primary care be more cost effective? Please show us some data so we can make up our own minds.

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  • Neil Bhatia

    Good luck recruiting 120 GPs to the area...

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  • Have a look at the reGROUP study which Exeter Uni are doing. The accumulating evidence suggests that larger practices, with a greater mix of staff, are more likely to fail. This is industrialised, dehumanised primary care, and those 120 GP chairs are going to be challenging to fill, since essentially you will be a GP cog in a large Primary Care Machine, with little autonomy and control, except via your contract.

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