What is this programme?
NHS England has produced the GP resilience programme, first announced in the GP Forward View, to help GP practices who are struggling. Local teams have been allocated money to help practices that are lacking ‘resilience’ locally. These local teams are likely to be the CCG, but in some areas could cover a wider area.
Which practices are eligible?
Local teams will be responsible for identifying practices at risk, but NHS England has some suggested national criteria. These include:
- an ‘inadequate’ or ‘requires improvement’ CQC rating;
- high ratio of patients to full-time equivalent GPs and/or nurses;
- support from the LMC, CCG or NHS England local area team (as this indicates that external bodies have significant concerns about the practice)
- significant practice changes,
- professional isolation,
- lower QOF achievement,
- referral or prescribing performance compared to CCG average,
- a closed list,
- and poor scores on the GP patient survey.
They may also use CCG ‘local intelligence’ to determine practices at risk.
Local teams will also use a ‘resilience and support matrix’ to determine how much support practices need, based on the scope for support (how much evidence there is that support is needed) and impact of support (whether the support would help solve the practice’s problems).
How do I access the help?
Local teams will identify practices that need the support, either because they are already vulnerable or are at risk of becoming so. This list will be reviewed every six months. Practices can also self-refer to the programme, although this process will vary by area. Local teams should have a named contact for practices to get in touch with.
The method of application will vary area by area but the local LMC should know what is happening in your region, so get in touch with them and the CCG to see if you could be eligible and make your case.
The deadline for local teams to identify practices for support in 2016/17 has been extended to 18 October. However, there may be some local flexibility in this. Local teams will confirm the full investment, by showing evidence of the funding being fully committed to named practices, by 30 December.
What should I include in my case?
If you do self-refer to the fund, the process will vary depending on area. However, the GPC advises that you demonstrate what the problems are for your practice and how this threatens your viability, and how you match the criteria above, with facts and figures being especially useful.
Dr Dean Eggitt, medical secretary at Doncaster LMC, told Pulse that he recommends all practices have a one-sheet business plan that they send to the CCG all year to access whatever funding is available. This should state specific examples of what you want, which could range from new hardware to business training for the practice manager. It would cover: the problem, the potential solution, how much it’s going to cost, and how you’re going to prove that it had a positive outcome.
What support will be available?
NHS England has identified a ‘menu of support’ for practices which will be tailored to the needs of practices in local areas. However, the support is locally determined so it is up to the local team what support they offer.
Items on the ‘menu’ that could be offered include:
- Diagnostic services to quickly identify areas for improvement support, specialist advice and guidance, for example in IT, HR, management or finance
- Coaching, supervision or mentorship
- Practice manager capacity support, for example providing cover for staff on leave
- Rapid intervention for practices at risk of closure,
- Support for practices with workforce issues, for example, local teams funding indemnity and GMC costs for a pool of GPs in return for them working in local practices
- Change management and improvement support to individual practices, which is support with making changes to get better systems in the practice
Local teams may deliver the support in several ways, for example creating ‘local resilience teams’ (made up of various staff including practice managers, nurses, GPs, and those with specific expertise to work with practices), contracting others to work with practices (for example GP federations), backfill costs for GPs or practice team members or Section 96 Support and Financial Assistance (which allows commissioners to give financial assistance directly to practices).
What will the practice have to do?
Practices will need to show ‘matched commitment’ to the programme, by having an agreed action plan containing ‘clear milestones for exiting support’. Practices will not need to match funding although they ‘will be expected to enter into a non-legally binding Memorandum of Understanding (MOU) with NHS England’. There is a template MOU in NHS England guidance.
How much money is available?
NHS England is putting £40m into the GP resilience programme over the next four years. In 2016/17 there is £16m available, with £8m in the years afterwards. Different regions will get different levels of funding, with Yorkshire and the Humber receiving the most money (£1,593,913 in 2016/17) and North West London the least (£626,000 in 2016/17).
What other national support is out there?
There is an RCGP peer support programme for practices in CQC special measures and a £10m vulnerable practices fund which is started last year, but the money seems to be slow to be reaching practices, as Pulse reported.
There is also a NHS GP Health service being brought in to help develop ‘personal resilience’.
What support is there outside England?
Support outside England varies depending on region, so contact your local health board to see what support is available for you. In Wales, some health boards have employed additional doctors to plug gaps, in Scotland, some NHS boards offer direct support to practices, and in northern Ireland there is help on a case-by-case basis, but it will all vary depending on area.