Almost half of GPs could retire or cut hours in the West Midlands in the next five years, NHS leaders in charge of planning healthcare in the region have warned.
The warning is contained in the Herefordshire and Worcestershire sustainability and transformation plan (STP), which similarly to other regional plans is hoping to make the NHS more efficient by moving services out of hospital and into general practice.
But the plan, worked up by all the regional CCGs, trusts and councils in partnership, said that a ‘key risk’ with this strategy was that there would be ‘insufficient primary care staff’. It said the warning was based on the fact that ‘42% of West Midlands GP workforce expect to retire or reduce hours in the next five years’.
Despite this, the STP group pledged that by 2020, GPs ‘will have more time to focus on patient care by reducing the administration and developing the primary care skill mix’.
The plan said physician assistants and advanced practitioners would be hired to ‘free up GPs to spend more time on patients with most complex needs’.
Another risk highlighted in the plan included ‘inability to resolve fundamental barriers for primary care relating to indemnity and property liability that will compromise their ability to engage with partners in new models of care or contracting arrangements’.
NHS planning leads also fear ‘insufficient engagement’ from both clinicians and the public, the plan reveals.
The 44 sustainability plans across England all have to present a model for how their regional NHS services can change to fit within the funding envelope for the next five years.
In Herefordshire and Worcestershire, this will also include saving £3.7m from the GP prescribing budget, according to the document.
But the majority of initiatives are based around ‘joining up’ care to boost efficiency, such as for example expanding the use of tele/video conferencing in GP practices and nursing homes.
It said it would do this via ‘local primary care working “at scale”, developed through a “bottom-up” approach with practices working in partnership with community pharmacy, third sector and public sector services as well as community and mental health services’.
The plan said: ‘[T]he ability of primary care to continue to meet the changing needs of our population is at risk. Our approach will include investment from the transformation fund to ensure primary care remains sustainable and at the heart of delivery.
‘Our out of hospital care models will be based around the GP lists for local populations and this will support a shift of resource to enable out of hospital care to be a reality.’
It said the new models would ‘build on what is already working well and will embed social prescribing, health improvement and self-management, utilising digital solutions where possible to provide these at scale and support demand management in primary care’.
The STP was worked up by Worcestershire Acute Hospitals NHS Trust, NHS Herefordshire CCG, NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG, NHS Wyre Forest CCG, Vye Valle NHS Trust, Worcestershire Councy Council, Herefordshire County Council, 2gether NHS Foundation Trust and Worcestershire Health and Care.
The fears over GP workforce comes as a major BMA survey last year revealed that 34% of GPs were thinking of retiring in the next five years.
NHS England annouced a plan last week to set up a GP retention pilot for over-55s thinking of leaving the profession, offering them flexible working models.
This could include providing cover for other practices, taking on certain expert roles or becoming trainers or mentors, for example.
What are the sustainability and transformation plans proposing?
Pulse’s scrutiny of the 44 STPs have previously revealed how:
- GPs in one region of England may have to shoulder an increasing burden of patient care following the merger of two acute care trusts in Nottinghamshire;
- In Dorset, a plan for the sustainability of the local NHS suggests that a current 98 GP practices, operating at 135 sites, ‘will over-stretch’ local ‘workforce and finances’. It suggests that a ‘reduction in the number of sites’ would lead to a better provision of services ‘for more hours of the day and days of the week’;
- In Hampshire and Isle of Wight, a reduction in GP workload by almost a third is sought, while also significantly reducing patients’ face-to-face contact with primary care.
- In North London, practices with list sizes under 10,000 patients could face closure amid moves to create primary care ’hubs’ with lists of 30,000.
- In East Devon, more than half of community hospital beds could be closed.
- NHS managers are expecting GPs in one area of England to slash their prescribing costs by a ‘very ambitious’ 15%, while another is targeting 7%.