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Independents' Day

It is crunch time for the GP Forward View

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I met the rarest of people recently. A GP who has actually been helped to keep his small practice open by the health service.

He has been given vulnerable practice funding for a practice manager to come in one day a week to do all the administrative heavy lifting that he does not have time to do. Yes, an actual new member of staff in his practice, paid for by NHS England, to reduce his workload; a GP in trouble, given the support that he so desperately needed. As he looked at me with obvious relief, I nearly keeled over.

It is simple measures like this that support practices in trouble. Not funding that comes with 20 strings attached, a training scheme that you haven’t asked for or a ‘CQC-type’ inspection. And if I can understand what is needed, then it can’t be rocket science, but it has seemed either beyond the wit – or perhaps the will – of NHS bosses to design an effective scheme to support vulnerable practices.

The next few months will be crucial

Pulse has been calling for months for funding to be released to enable those at risk of closure to continue, and we found out recently that around a quarter have been classed by NHS England as eligible for their ‘resilience’ programme.

In itself, this is an extraordinary admission for the health service to make, and sadly it vindicates all the portentous warnings Pulse has given. It is perhaps too early to hope that 2017 will finally mark the year the health service deals with the crisis in general practice, but at least this is an encouraging sign managers understand the scale of the problem.

The next few months will be crucial. All CCGs in England have been tasked with submitting a plan to NHS England before Christmas on how they will implement the GP Forward View locally. These should contain significant new funding for practices: CCGs have been told to spend £3 per patient on general practice and some will receive an additional £6 per patient from April from NHS England. We list the areas that have so far promised extra funding for general practice today.

But – as ever – it’s not so straightforward. CCG funding must be allocated for ‘practice transformational support’ (no, I don’t know what that means either) and the £6 per patient is only for those areas with ‘successful’ seven-day GP access pilots. There is a new £45m pot that could be used for new members of staff, such as care navigators or medical assistants, but it also has to be used to widen use of online GP consultations.

So what could be a shot in the arm for practices is again tied up in red tape. We can only hope CCGs are more imaginative in how they interpret this guidance than area teams and that LMCs are involved at an early stage.

And, of course, the other crunch date will be 1 April. We understand negotiations on the new GP contract for next year are continuing, but how the expected 4% increase in funding under the GP Forward View is delivered will be a major test of NHS England’s intent to stabilise general practice.

But all this may be academic for the GP I started this column with. When I asked him about his future plans, he replied with a grin: ‘Oh, I’m looking to sell up. I’ve had enough.’ 

Nigel Praities is editor of Pulse

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Readers' comments (1)

  • Vinci Ho

    It is not just crunch time for general practice and NHS , it is crunch time for this country(or one can argue that is for the world as well).
    Fundamentally, it has been about what people believe(d), the rhetorics and slogans were plentiful but short of real meanings. The plans(A ,B or even C) were set out to be exhilarating but could easily crash into emptiness on delivery . Is GPFV a gospel or a myth? So much money in numerical figures are put on the table for primary care but one is not supposed to touch them without fulfilling X,Y and Z. There is certainly no new money but only 22 billions target of efficiency saving. So, where does this all lead to? There might be a political will somewhere but we are yet to see a political way.
    Societies are deeply polarised alongside a wide socioeconomic gap. Liberalism had not been necessarily equality friendly . The liberal market has ,in fact , taken the socioeconomic gap for granted instead . This has become a chronic pathology in western democracies. People deprived of the shares of success from globalisation have turned up their rebellions towards their governments.
    Many months ago , I had commented that a government had the historical responsibility of preventing right winged ideology creeping into the mainstream in a time of economic downturn. Unfortunately, we are now totally dominated in this country by Brexit which is primarily about immigration under the roof of nationalism. George Orwell wrote specifically about nationalism and one would be amazed how his words are still vividly meaningful today . If patriotism is about loving own country and its people , nationalism represents the hatred of people outside .
    The debates leading up to Brexit had nothing more than further dividing our already polarised society . Political discourses and expression of opinions had become war between at least ,two tribes. The environment created is so toxic that even journalists felt suffocated and exhausted . Ian Heslop , Laura Keunssberg and even a Sky News editor all felt the pressure.
    If you are not in my camp , you are the 'bad guy' and needs to be punished . Only the relative majority had the 'freedom' of speech and expression. One would argue this attitude precipitated the tragedy of Jo Cox.
    Brexit also provided the absolute excuse for the government to avoid tackling all domestic issues; Education and Health both with serious funding issues, transport crippled by the ongoing , escalating strikes through Christmas , justice system embarrassed by prison riots not seen since the 70s and last but not the least , social care of our elderly patients in the verge of collapse due to historically low funding (wait until the minimum living wage to effect from 1st April next year) which could never be mended by simply raising council tax prematurely by 2%(no new money overall).
    So , what have our politicians in charge of the government been doing ? Nothing much because nobody seems to have a clue , a vision and the courage to face the reality. In times like this , we need our politicians to be even more humble with humility and honour . The PM might want to think she was the chosen one for the people but failed to realise the lavishness of her nine hundred odd quid leather trousers(all her expensive shoes as well)did not paint her a frugal leader image to the common public . Criticising on this matter ,poor Nicky Morgan was called ' that woman' by the PM's faithful sidekick but of course , her own handbag was worth about the same price.
    If the Cameron/Osborne government had gone bankrupt on trust and credibility, this current government has no political currency to start with , as neither the PM nor the Chancellor were selected through a general election .
    To me , both patriotism and nationalism are both overrated (except in time when a country is invaded and occupied by a foreign power), the priority is still the well beings of people , common people. Failing to uphold the duty of serving this , a government has no leg to stand on.

    ''We have now sunk to a depth at which the restatement of the obvious is the first duty of intelligent men.'' George Orwell

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