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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.