Neighbourhood transformation is ‘very far away’, says BMA’s GP leader

Neighbourhood health transformation is ‘very far away’, the chair of the BMA’s GP Committee has said, as GP leaders questioned whether the workforce and funding exist to deliver Government ambitions.

Speaking at a Westminster Health Forum conference on the 10-year health plan yesterday, Dr Katie Bramall said there was a growing gap between political rhetoric and what was realistically achievable in general practice.

‘We are very far away from any transformation here, even though everyone just wants to talk about it and gets very excited about it,’ she said.

Dr Bramall said the lack of funding meant neighbourhood reform risked stalling before it began.

‘Transformation costs money, and if there isn’t any, I only see sclerosis and the status quo,’ she said.

She warned that overselling reform without the resources to deliver it would damage trust.

‘Promising the world and delivering the status quo is going to let down patients, the Government and the profession,’ she said.

Neighbourhood health featured prominently in the Government’s 10-year health plan, which set out proposals to deliver more care outside hospitals by bringing together general practice, community services and other providers in new footprints.

As previously reported by Pulse, the plan described neighbourhood services serving populations of around 30,000 to 50,000 people, building on existing primary care networks (PCNs). The plan also proposed two new neighbourhood contract models, to sit alongside existing GP contracts.

However, it did not set out detail on how the contracts would be funded, how they would interact with GMS contracts or PCNs, or whether participation would be mandatory for GP practices.

The plan also referred to a potential role for integrated health organisations (IHOs) in holding neighbourhood-level contracts, and hospital trusts have been invited to bid to progress towards this status.

However, speaking at yesterday’s virtual conference, Dr Bramall suggested neighbourhood contracts were unlikely to be introduced in the near future, even in limited form.

She said: ‘I don’t want to get too distracted by this, because there’s a complete paucity of anything to work with. It’s very clear we’re not going to these contracts this year.’

Last year, she had raised concerns over potential plans to divert enhanced services funding away from GP practices to fund new neighbourhood contracts. 

And yesterday she added: ‘If there’s any appetite for trying to gather up locally commissioned services, they will require at least six months notice on those contracts.’

GP leaders also highlighted that the lack of detail continued to create uncertainty about the future role and footprint of PCNs at the conference.

RCGP chair Dr Victoria Tzortziou Brown said: ‘We need to have a really clear role for neighbourhoods and a really clear role for PCNs. And this clarity has not been forthcoming as yet.’

And Dr Bramall said the plans raised some concerns about ‘potential breach notices’ for outlier PCNs that were not aligned to neighbourhoods.

Dr Tzortziou Brown also warned against sacrificing continuity in the pursuit of access targets.

‘Triage controls queues, while continuity controls demand,’ she said.

And she cautioned that models which fragment care risked increasing long-term workload rather than easing pressure on general practice.

She said: ‘We need to be really, really careful not to sacrifice continuity, because we may win the battle on flows but actually we may lose the battle on workload and meaningful care.’

On GP workforce, Dr Tzortziou Brown reiterated the College’s bid for the updated long-term workforce plan to include a national GP retention strategy.

The GPC chair also highlighted workforce pressures, saying headline GP numbers masked the loss of experienced doctors.

Dr Bramall said: ‘We are haemorrhaging really experienced GPs. Those are the GPs who have been partners in their practices, who know their populations, who have the knowledge of their patients encyclopaedically well – and you cannot replace like for like.’

She added that newly-qualified GPs were struggling to find substantive work in the NHS.

‘We have GPs completing their training and they cannot get enough work in the NHS,’ she said.

It comes as legislation prioritising UK medical graduates for foundation and specialty training is being being introduced to Parliament today.