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A faulty production line

What could a ‘new deal’ for GPs look like?

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Some well-connected sources tell us that the promised ‘new deal’ for general practice is proving a real headache within the Department of Health.

The health secretary’s Rooseveltian moment occurred on BBC Radio 4 last month where he promised he would set out new arrangements for GPs that would address the spiralling demands on the service.

‘We need to look at the terms and conditions of general practice; we need to look at why GPs have so much burnout’, he said. But his promise has left civil servants scratching their heads.

After this build up, Mr Hunt needs to make the profession a big offer, but in a time of financial austerity he has very little wiggle room. The politics are also difficult, with an ever-watchful Daily Mail ready to pounce on anything that looks like a handout to GPs.

Apart from some dark mutterings about locum terms and conditions, there is very little sign of what he will come up with. But perhaps he is not speaking with the right people, because I could give him a whole list.

Focussing on the immediate, relief from the box-ticking and petty paper-shifting of DESs, the QOF and CQC inspections and, perhaps, even lengthening the frequency of revalidation would prove welcome.

Stabilising practice income would also help – putting a halt to all PMS reviews, the MPIG withdrawal and the pointless shifting of the contractual goal posts every single year.

But the biggest problem at the moment is the GP workforce. We must forget about the mythical 5,000 more GPs, they will come too late (if at all) to do any good. Professor Martin Roland’s review of the workforce for Health Education England will be published soon and I would not be surprised if he recommends more pharmacists in practices, health trainers and physician associates to help practices cope. Potentially a salve that could be prioritised immediately.

And the last thing we come to is premises. NHS England chief executive Simon Stevens’ vision of GP practices expanding to secondary care, community and social care services makes sense, but only if there is something better than a musty back room to house them.

The £250m injection into practice premises projects this year was a good start, but more is needed. Managers need to work more closely to give practices the ability to upgrade and expand, and then community and social services can be wrapped around them to better support patients outside of hospital.

And this is the clever bit. None of this looks like a payment to GPs, but it could make all the difference. But what do I know, I’m just a journalist.

Nigel Praities is editor of Pulse

What would you like to see in the ‘new deal’? Sound off in the comments below…

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Readers' comments (21)

  • Good article.

    How about an independent body to oversee health in the UK and the obvious underfunding and the need to massively increase funding? This could then happen without the politicians getting blamed.

    Payment by activity, £10 to see your GP or £20 to go to A&E, co-payments and insurance (like the rest of the western world whose most disadvantaged receive better care). GPs to go private like the dentists.

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  • Dear Nigel, you may think you are "just" a journalist, but you speak more sense than all the politicians in Westminster, and more sense than the RCGP and BMA together. I would be happy to have you negotiate on my behalf, because you appear to really understand the major problems facing GPs today. Please keep up the good work.

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  • Agree with the above. If you were able to set up a union for GPs I think it would be a landslide.

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  • Vinci Ho

    May be we can look at this from different angles:
    (1) What was the political circumstances when the Tories made these pledges e.g. 7 days access and additional 5000 GPs, BEFORE the general election . It was a 'passive' response because the opposition parties were pushing so hard using NHS as their weapon. Deep down , NHS is a pain in the a*se for most Tories. DC and GO only really care about GDP and economy. (hence the theory:you can only have NHS if the economy is good enough, I wonder what William Beveridge would say if he was still alive today). Furthermore , most public polls(of course, one can challenge their credibility now)before the election suggested people trusted Tories the least on NHS(mirror image to economy). I am not sure whether many Tories really believed they could win the election by a majority that time. Now , they won it but as Chinese in Homg Kong often said 'you have already got your hair wet' , DC has to provide some answers whether he likes it or not.
    (2) Question is : are the 'solutions' kind of aggressive or regressive? Keeping JH as the health secretary may be insightful considering how bad the relationship between the government and GPs had turned since he appeared on the front stage. I am pessimists on this respect.
    (3) Then it came the 'messiah' , SS, who appeared to be 'understanding' and addressed things had to be done differently . Different models to deliver care were proposed but they were all corporate mechanisms. He paved the way for JH to rubber stamp the policy that you will not get more money unless you belong to a large federation ( the Northern Ireland policy?). That could be the prerequisite for any new deal. However, if the Tories really want to have any chance to get re-elected in 2020(something they will have to start thinking about soon), they cannot shy away from these promises which can really be delivered only by more investment in primary care. (though DC did try to avoid the subject by saying seven days NHS could be delivered without much more money!)
    (4) The only 'positive' I had recognised so far , on the contrary ,was SS's high profile criticism of GPs moaning (thanks to Pulse) all the bloody time and to some ,this could have prevented young GPs to join in . But I would say he did not even need to mention this if the political energy of these moaning was negligible in interfering the politicians' thinking. Look how many of them are jumping the bandwagon to talk about shortage of GPs , closure of GP surgeries in House of Common right now ?
    (5) As Newtonian physics stated : Whenever there is an action, there is a reaction. Do not underestimate our 'reaction' in this ongoing battle......,.
    But what do I know , I am only a bloody GP.......

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  • @ Vinci Ho

    GPs need to adopt the dentists approach and have the balls to go private.

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  • Dentists didn't have 'balls ' to go private. Their reimbursements had become so minimal they had no choice.

    Now dentists can and do earn far higher sums then any doctor does, but they work for it. In our growing part time working culture in medicine how may medics would be able to cope with a truly commercial approach?

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  • and physician associates to help spread practices cope. Potentially a salve that could be prioritised immediately.

    Missing word in this sentence?

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  • Good spot

  • So...
    - Private property investors will be encouraged to buy up existing practices and rent them back and/or develop new larger sites for co-location with multiple practices and other services.
    - The GP contract will continue to be squeezed until the new one is announced (a hybrid of APMS, probably with protection for corporates from risk - ie it can be held by Ltd/LLP). The hope will be that as the final pips squeek in late 2016, the entire proffession will shoot like the treasurer's champagne cork out of the GMS bottle, and into the waiting arms of a privatised salaried contract model.
    - The plethora of GP federations will actively consolidate many small practices in the interim, making the task of M&A far simpler for the large corporates.
    - Care will shift towards video conferencing rather than face to face care, with many patients able to directly access a specialist and a smaller number being 'pre-filtered' through an online GP consult.

    Happy days.

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  • Nothing short of a 30% rise in income - to restore rewards to 2004 level - will have any effect . At least you can take that to the bank.

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  • Payment by activity is in place already - DES, LES, QOF, KPI. Do we want to make the whole things PBR, yes in my opinion we do. Thus we can stop moaning about workload! More work more money, less work ............
    May be we need to look at the other parts of the world ? may be we need to look at the other parts of the NHS!

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