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CAMHS won't see you now

Simon Stevens' message to GPs – expand or die

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The new Five Year Forward View from NHS England is the first major policy document since its new chief executive took over in April. And it underlines a new style of leadership.

In contrast to most NHS England documents, it is readable and focussed. For a five-year plan, it should have much more detail on how its aims will be achieved. But it is refreshing to see NHS England setting its own mandate (rather than waiting for ministers to impose one).

It is savvy in its timing as well. Telling politicians that the additional money they have promised for the NHS is not enough months before a general election – it says there will be a £8bn gap even after continued ‘efficiency savings’ – will set the tone of the debate over the NHS.

GPs are also front and centre - there is even a GP treating a young child on the cover.

It admits that GPs are under ‘severe strain’ and promises a ‘new deal’ for the profession, with core funding stabilised for the next two years*, more cash released to ‘upgrade primary care infrastructure’ and an urgent focus on attracting GPs to underdoctored areas.

The proverbial devil will be lurking in the detail, but it is certainly a step in the right direction by Mr Stevens. He has clearly listened to the RCGP, GPC and our own Stop Practice Closures campaign.

But the most radical part of the document looks at how GPs will drive a revolution in how care is provided outside hospital.

It envisages practices forming the rather clumsily worded ‘multispeciality community providers’.

Federations or networks of practices will involve consultants, community services and social workers to shift the majority of outpatient care into the community. They will also run community hospitals, admit patients and – in time – perhaps even take over the whole budget for their registered patient list.

Quite how GPs will be given the headroom to take on these expanded roles is unclear. And although the document explicitly states that there will be space for single-handed GPs, it is difficult to believe that they can lead to anything other than an acceleration of the creeping corporatisation of general practice.

And there is a sting in the tail. The document also says that hospitals will be allowed to open their own GP surgeries in areas where ‘general practice is under strain’ for the first time.

It says that there will have to be ‘safeguards’ to ensure that these new hospital-run practices do not just become a ‘feeder’ for expanding secondary care activity. But the implications of this are clear.

Mr Stevens has thrown down the gauntlet to GPs. Expand or watch hospitals gobble you up.

Nigel Praities is editor of Pulse

*Update at 17:09: Although NHS England has confirmed that the current schedule of PMS reviews and MPIG cuts will remain - so not much stability there.

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Readers' comments (7)

  • the interesting thing he said this am on radio 4 was he hoped hospitals would have the money on their balance sheets to invest in primary care - presumably this is ?premises? IT? while on the face of it this sounds interesting it actually unfair - i have to run my practice on the money im given in my contract. a hospital can compete with me and use the money it gets from its secondary care contract (which is tariff and activity based) so they admit loads of people - make more money and put that money into their GP surgery to compete with me and close me down.... anyone see where this leads... more cost. ok they mention safeguards... lets see if there referral rates and admission rates are lower than ours....or not.

    we need a new deal - allow us to hold contracts as LTd companies, have non doctor investors, allow sale of good will and then we will get an injection of investment and some serious management. I know several VCs who would happily punt on working with GPs.

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  • I bet the Mr Stevens will be long gone before this plan even gets looked at. More pi**ing in the wind as usual

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  • a plan that impossible to achieve with no clear operational or implementation strategy. In addition there is little thought on the consequences of the proposals. And the plan relies on further efficency savings almost equal to the nicholson challenge? This was not achieved fully and only partially due to counting reserves and pay restraint. There is no more financial efficiency left in the NHS. The expectation to provide more on a slashed budget (and 8billion is pocket change for what is really required) is a force.

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  • .... Farce!

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  • Gps have been killed long before by The PCTs with their impising unworkable conditions nd enforciong non evidence based medicines on gP.The older colleagues resign or are threatened beingstruck off for not bowing To PCT's demands.The newere GPs sensibly get their degrees and move to better pastures

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  • Whilst I welcome the proposition for a greater proportion of funds being diverted to general practice, the promise is only to stabilise, not increase practice funding in the next 2 years. This is simply not enough. It is worth reading the September 2014 NHS Business Services Authority Pensions Newsletter. Forcing GPs to federate will decrease GP pensions as profit allocated to practices through GP federations is non-NHS pensionable. So worse hours, worse terms and conditions and now worse pension than the rest of the NHS. Who would want to be a GP? Why are our leaders backing federations when this will deprive GPs of a significant proportion of their NHS pension? And why is this not being flagged to GPs being pushed down the federate or bust route?

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  • Can the anonymous 1st post at 11.17 please elaborate as our PRG are encountering substantial problems & have done for more than 18 months. We are non core Health Care who have had to deal with one of the biggest PLC GP service providers in the NHS & despite the Committee being all professionals ( as opposed to just complaining) we still struggle with them. We have a meeting with them tomorrow & 2 Directors will be in attendance; that has never fazed us! But the Service levels are still extremely pretty poor but have been improving. The appointment & GP/Patient ratio is ludicrous but getting better. It will never return to a conventional GP practice but any enlightenment from you would be appreciated.

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