NHS leaders are promising a transformation of GP services in London, which will involve a ‘shift of resources’ from secondary to primary care, the potential end of enhanced services and practices joining federations to improve access for patients.
The ‘call to action’ consultation document for primary care, issued by the London NHS England local area team, represents former RCGP chair Dr Clare Gerada’s first major piece of work since she took her new part-time role at NHS England as chair of London’s Primary Care Clinical Board.
The consultation ends in April 2014, and – while there are no concrete proposals – the document signals a ‘direction of travel’ that will see resources being shifted into primary care, Dr Gerada said.
The report said that ‘practice finances are declining in real terms’, and ‘delivering smaller pump-prime investment in primary care initiatives has the potential to release greater cost efficiencies over time’.
It added: ‘London needs to deliver an economic analysis that identifies the cost efficiencies that can be achieved by investment in building primary care capacity and capability.’
Dr Gerada, who is a co-author of the report, told Pulse that this document signals that NHS managers are committed to increasing investment in primary care.
She said: ‘If you read between the lines, you cannot expect general practice to transform unless you put in the resources to support that transformation and maintain that transformation. So you can’t do this as far as I’m concerned without additional resource or redistributing the resource that currently exists in the NHS.’
‘I’m not the chief executive of NHS London so I can’t say “this is what NHS London is going to do”. All I can say is the publication of this document, the fact that I’m there and that we’re looking to transform primary care, show that clearly NHS London has an enormous investment for primary care.’
The document said primary care in the capital is under ‘unprecedented strain’ and ‘tweaking around the edges will not be an option’.
It listed a number of challenges in London, including a booming population, difficulties in registering with a local doctor, stark health inequalities across London and lower patient satisfaction with GP services than the rest of the country.
The document emphasised that Londoners wanted to see GPs at all times, and said that practices may need to federate to enable this to happen.
It said: ‘Most practices continue to be open Monday to Friday 4.5 days a week. Many patients do not have access to their general practice outside of working hours and as a result need to take time off in order to see a GP or practice nurse.’
‘Offering greater opening time and appointment ﬂexibility is important. Where the logistics of stafﬁng receptions and clinics over extended opening periods proves difﬁcult joint solutions may be required across practice networks.’
The document also called for an end to enhanced services. It said: ‘There is a need to end the piecemeal reward of enhanced services from general practice – a process that for any small enterprise adds to the financial uncertainty and inability to plan effectively for the future. Service developments need to be appropriately contracted for and funded with opportunities to tailor these to local population needs where required.’
Dr Gerada said that enhanced services lead to GPs losing money. She added: ‘Things like smoking cessation: separating that out as a separate enhanced service just doesn’t work because GPs do it anyway.’
‘Carving it up and contracting it out would mean we lose money. We’re going to be consulting in the next few weeks on this. We’re not going to impose anything. This will be consulted on. The detail will be worked out. We need to set a direction of travel and allow people to work out how it works locally without any major structural change – that’s probably the best way to do it.’
Dr Michelle Drage, chief executive of Londonwide LMCs, said: ‘Every week in London, one million patients consult their GP face to face, with more than double that number accessing other GP services from their surgeries and medical centres. Given the diversity/complexity of Londoner’s health and the high levels of patient satisfaction, it shows that London’s GP service which provides 90% of NHS activity with only 7.5% (and falling) of the NHS resources, is nothing short of miraculous.’
‘And yet we could do so much more if two things in particular changed: Firstly, practices need to be supported by good quality district nurses, health visitors, mental health and social services centred around their patient communities to enable effective joined-up care to take place out of hospital. Secondly, London’s primary care needs a £1bn funding boost so that patients in the capital can be assured that they can always access the high level of general practice services that they deserve.’
Note: This article was changed at 9:50am on 28/11/2013. It originally said the managers were planning a shift of resources from primary to secondary care. It was meant to say a shift from secondary to primary care. Apologies for any confusion.