Exclusive GP practices on the brink of closure are to be offered ‘change management’ support from management consultants KPMG, paid for with money from the GP Forward View rescue package.
NHS Chiltern CCG and NHS Aylesbury Vale CCG announced this month that they have together ‘committed up to £110,000’ from the national £40m GP Resilience Programme to buy in management consultants to help GP practices work at scale.
The contract was awarded to KPMG and GP federation FedBucks in the hopes that KPMG’s ‘knowledge will be cascaded’ to local GPs who can provide support in future without an external provider.
KPMG told Pulse it would help with initial work to ‘scale-up’ GP services but afterwards CCG and practice staff would be left ‘with the skills to continue to be resilient’.
But GP leaders told Pulse that the fund for struggling practices appeared to have become yet another push towards NHS England’s vision for ‘transformation’ without any uplift of the long-term funding for core services.
CCG minutes from 9 March show that 17 practices in the Buckinghamshire area self-referred or were put forward for support from the General Practice Resilience Programme last year (2016/17) – though not all of the bids were deemed appropriate.
The two CCGs told Pulse that the contract it had awarded would be paid for from its first year’s slice of funding, which amounts to £114,000 in 2016/17 when combined across Aylesbury Vale and Chiltern.
For this funding KPMG and FedBucks will have to create ‘practical solutions’ on how ‘practices clustered into populations of around 50,000’ can benefit from support by staff in community care multidisciplinary teams.
This comes after NHS England pledged in March to fund practices to work together in groups of 30,000 to 50,000 patients, a number which it said practices were ‘organically’ moving towards because of the efficiency savings to be had.
The two Buckinghamshire CCGs told Pulse that ‘a second aim [of the contract] is to create a support package for vulnerable practices.’
A spokesperson added: ‘Over time this expertise and knowledge will be cascaded to local GP leaders to grow local expertise and build capability to provide this service without having to seek external support.’
The Resilience Programme will provide another £114,000 to the region between now and March 2019 which is currently being held back to address any ‘follow-up work needed as a result of this project’.
Berkshire, Buckinghamshire, and Oxfordshire LMCs chief executive Dr Paul Roblin said working at scale could help practices but added that ‘it doesn’t address the problem of a fundamental lack of resourcing of primary care’.
He said: ‘Until you resolve that mismatch you won’t get very far it’s a sticking plaster.’
Dr Roblin said that this comes as ‘virtually every practice is one resignation from a problematic situation because it’s so difficult to recruit’.
He added: ‘It’s basically serendipity who avoids the illnesses and retirements.’
A KPMG spokesperson said that the contract would see it provide a team of ‘advisory experts with health backgrounds and GPs, who bring with them expertise from delivering similar projects in other parts of the country’.
They added: ‘KPMG is working in partnership with FedBucks to deliver a development programme to GP practices in Buckinghamshire, which aims to ensure practices can deliver a sustainable service in future as demand continues to increase…
‘We will help practices develop options for how they can scale up, and how they can work collaboratively with other GP practices, health and care providers in the region to provide a more resilient and service.
‘What’s really great about this project, is that we will leave CCG and practice staff with the skills to continue to be resilient long after our commitment has ended.’
NHS England’s programme of funding to stop practice closures
The General Practice Resilience Programme commitment in the GP Forward View pledged £40m to support struggling practices up to 2020.
In its first year NHS England pledged to make £16m available, however Pulse showed that delays getting this to CCGs led to funding being rushed out before the April 2017 deadline.
Practices can self-refer for support from the scheme, but the type of support available is determined by the CCG.
NHS England guidance says the ‘menu of support’ that the fund can be spent on includes ‘rapid intervention and management support for practices at risk of closure, support with workforce issues, and ‘change management’.
This followed up from a £10m emergency turnaround fund for vulnerable practices announced by NHS England in 2015, which Pulse showed had only been 40% spent one year later.