ICBs have paid for private management consultants to help design GP strategies and improve access, Pulse has found.
KPMG and PricewaterhouseCoopers (PwC) have been commissioned to undertake work such as modelling of demand in general practice, developing a primary care strategy, and designing a ‘more sustainable’ model of primary care.
NHS England asked ICBs to provide an update on progress against the GP recovery plan in their October or November public board meetings.
Within these reports, Pulse found that three ICBs – Black Country, North West London (NWL), and Buckinghamshire, Oxfordshire and Berkshire West (BOB) – referred to partnerships with management consultancies.
In Black Country, health leaders announced that PwC had been ‘selected to support the primary care team in the design of a model of primary care that creates a more sustainable model of general practice for the future’.
The ICB told Pulse the contract with PwC will provide ‘additional support’ for primary care transformation.
Director of primary care Sarb Basi said: ‘As an ICB we are committed to working with primary care in the Black Country to achieve transformation that will future proof the service, support GPs and community pharmacists, and meet local patient need.
‘We recognise that this is something which needs focused resource and to achieve this we have invested in additional support to help develop our five-year primary care transformation strategy, with all stakeholders appropriately engaged.’
North West London ICB has commissioned KPMG to ‘undertake an analysis of the current pattern of demand’ on same-day services, including primary care, and also to support on a PCN project.
‘The service redesign component is intended to support all 45 PCNs over four waves to develop and redesign their services to offer improved access to patients as part of a “Neighbourhood and Borough” model of same-day care,’ the report said.
It added that each PCN is supported by a ‘combined KPMG and ICB team through weekly touch points’.
The ICB told Pulse that it commissioned KPMG due to the ‘intensity of complexity’ associated with redesigning services, and to provide ‘additional capacity’ while the ICB team is focused on other primary care transformation work.
‘It is still early days but initial feedback from the PCNs that have launched Same-Day Access Hubs include high utilisation rates, extra appointments being provided, much greater resolution of consultations without follow-up appointments being needed and a high patient satisfaction rate, including patients noticing that they are getting appointments more quickly,’ they added.
Local commissioners across BOB reported that KPMG is their ‘support partner’ on the primary care strategy, and also ‘supporting on components of the financial model’.
Pulse reached out to the ICB for comment but did not receive a response.
GP spokesperson for the Doctors’ Association UK (DAUK) Dr Steve Taylor said he is not opposed to ICBs developing strategies, but they ‘should be asking some of the doctors that are running good services’ to provide advice ‘rather than getting management consultants in’.
He told Pulse: ‘I think the problem with using outside agencies is that they don’t have enough on-the-ground understanding of how the processes work to actually unpick it. So they come up with thoughts and plans that don’t seem to match what can be delivered on the ground.
‘I think part of the problem is that ICBs nowadays have got less and less GPs involved in their boards, as opposed to CCGs which had higher number of GPs as a proportion.
‘It appears to me that ICBs are not asking the right people. They could be getting better advice from people that are working day in day out on the ground, and understand the processes and the needs of general practice.’
Management consultancies have been involved in GP strategies in the past – in 2018, NHS Digital paid £1.2m for McKinsey & Company to assist with its overhaul of GP IT systems, and the year before, KPMG was handed over £100,000 worth of GP ‘resilience’ funding in one area.
The autumn board reports from all 42 ICBs across England also revealed that only three areas had met NHS England’s GP recovery target to expand self-referral pathways by the end of September.
And many local commissioners said GP practices are struggling to find time to take part in NHSE’s recovery training offers, such as the General Practice Improvement Programme (GPIP).
Let’s have a series of meetings to decide whether this is a good use of NHS and taxpayers cash whilst maintaining those touch points
I recall many years ago in Tower Hamlets, my Trainer (I was a registrar) used to do 2.5hrs am clinics and 2 hrs pm clinics. Still never left the building on time.
They then paid McKinsey to do some work on GP capacity and access. After spending significant amounts of money, they revolutionised healthcare and access in Tower Hamlets.
These guys are the best of the best and the results they delivered still reverberates through Tower Hamlets today. I felt compelled to write this as I know many people will be bashing these organisation. Perhaps I feel a little jealous that they were able to solve problem none of us could. Perhaps their birds eye over view was all that was needed. To this day I marvel at the work these boys and girls do for us and every penny of it is worth it.
And.. oh if your are wondering what spending millions got us and how they solved the GP access issue… well they figured if we did 2 x 3hr shifts then we would in theory be able to see more patients. This would lead to more access and hence solve all our problems. You see, they saw what none of us could. If we worked longer hours then that would lead to greater access. Sounds simple, but it’d taken a team of McKinsey boffs to figure it out.
I feel its time to get the McKinsey boys and girls back in again.
The house is burning down, and now they are paying someone to pour petrol on it. Brilliant
If they offered the money to the local practices to improve their own access by adding more clinics or hours, it would be problem solved! But why listen to people on the ground who do the work when you can waste money on people with no clue but who will state “do more hours” or “decrease appointment times from 10 mintues to 7.5 minutes”. Magic.
Hourly rate for Consultants to cover their own junior during the strikes £250/hr. wowsers.The lunatic a defo taken over the assylum.Roll on April.
the problem is not access, it is capacity.
the capacity problem is due to lack of funding and lack of a long term workforce strategy.
the lack of funding and a longterm workforce strategy are consequences of political decisions made by NHSE and the government.
NHSE’s preferred answer appears to be to move towards a macdonald’s type of fast-medicine service: you can’t see a doctor, but you can see *someone* quickly, even if they can’t actually do much other than refer you on to an 18 month waiting list to see someone who can do something.
this will appear on paper to be cheaper (but will actually turn out to be much more expensive due to over-investigation, over-referral, and litigation), mostly run by people (who aren’t doctors, and who aren’t likely to be difficult and act as patient advocates) working to strict protocols, and it will be significantly less safe.
like hospitals, in other words.
both safety and productivity will fall off a cliff – as they have already in secondary care.
patients will hate it, but it will be all the NHS offers the masses. those who can afford to will move into a private system, which will continue to function and offer care like the old style general practice (because it is blindingly obviously the best and safest system).
doctors won’t want to work in the new NHS system full time, which will mostly be supervising other staff – although many might do a bit of pro bono work, like in the 1930s, but will then work mostly in the private system as it will be better terms and conditions and offer more satisfying medical practice.
to be clear, management consultants are not being brought in to redesign the system – they are being brought in to find a publicly-plausible rationale to switch to the system above that NHSE has pre-ordained it wants – and then take responsibility for the switch when it is a disaster. this will enable NHSE to shrug their collective shoulders at the disaster and say ‘we had no choice’ and ‘we were told it was necessary by experts’.
the senior management consultants won’t be doing the work, of course – this will be done by a large team of 25 years olds being paid £1-2K per day, whilst a senior person schmoozes the ICB senior management every couple of weeks.
What a waste of money. I could have advised them for free.
Why not pay GPs to improve GP access?
Agree with Davis mummery
PwC employ bright university graduates, and pay them well.
The NHS could recruit the same bright university graduates and pay them well too.
We’d then have a capable workforce that could not only come up with mindnumbingly obvious example above that we need to work more hours to get through more work, but also help do some of it.
Great baiting satire piece by “Shah Ali” above. I’m still crying with laughter much like McKinsey must have done…all the way to the bank.
Perhaps one day we’ll read a piece on Pulse titled “ICBs pay GPs to help improve GP access”. One can dream..
Free-at-the-point-of-delivery is such a bizarre business model that it will flummox the brightest young management consultant, despite their eye-watering fees. They also can’t do much about an ageing population. I would rate their chances of success alongside those of King Canute. “Tech” would not have helped him much, and I am not sure it will help our access either!
Ditto everything above. I’d like to see the diversity profile of the boys and gals from McKinsey who work on this project. One of the fundamental problems lies in the fact that these 3 ICBs have effectively all commissioned McKinsey to do the same thing. They all report up via their individual structures to their boards “we’ve done this….” but would any of these managers ever have the guts to say “Ooh err, next door ICBs commissioned a project, can we piggyback?”. No, we need our own project/strategy/policy/group/committee to sort these nationwide commonalities is part of the problem. Gzillions of public money is wasted by NHS managers who have no incentive to think beyond their keyboards.
This is one of those articles which makes me check it’s not 1st April.
The introductory / accompanying photo say it all really. A perception of reality – a chap who likely wouldn’t know where to put a stethoscope presenting a nonsense graph to a bunch of, apparently, teenagers with the inevitable accompaniment of cardboard dressed coffees.
Well done. Pulse.
Oddly in another Pulse article, a ‘minister says ‘finding extra funding for GPs will be extremely difficult.’
Doomed.
Access issues??
ICBs should return general practice back to the good old days.
Simply make GPs do 2×4 hour surgeries per day,
7.5 minute appointments like they used to in more efficient times, that’s 64 appointments per day.
They can do admin in their lunch break like everybody else.
They can do house calls on the way home.
Kick ‘em off committees, PCN boards etc and stick ‘em all back in front of patients.
They might moan, but there’s loads of ‘em on the dole right now, they’ll be grateful for the work.
Problem solved.
May I have my £1million Consultation Fee please?
I have a really radical idea to improve access. What if we actually spent money on prevention in the community so that we turn down the tap of demand. If 80% of a person’s health is determined by where and how they live and only 20% by timely access to good care, why don’t we spend a bit more of our GDP of making our people more healthy? It is much easier to stop someone from progressing to diabetes with a slightly abnormal HbA1c then pay for dialysis and leg amputations. What if we trained enough doctors and valued them enough to ensure they didn’t burn out after 2 years of seeing a huge amount of complex patients only because that looked the most efficient to a young KPMG graduate on paper. What if we spent a bit more than 10% on Primary Care and Public Health combined. We might see that it all magically improves both access AND experience as well as health and wellbeing all round. What if we followed Hilary Cottam’s advice in Radical Health and instead of spending 80% of our money on tick boxes, processes and flow charts and 20% on people, we reversed that ratio and spend 80% on people and 20% on processes to support them? But what do I know, I’m just a GP.