I met the rarest of people recently. A GP who has actually been helped to keep his small practice open by the health service.
He has been given vulnerable practice funding for a practice manager to come in one day a week to do all the administrative heavy lifting that he does not have time to do. Yes, an actual new member of staff in his practice, paid for by NHS England, to reduce his workload; a GP in trouble, given the support that he so desperately needed. As he looked at me with obvious relief, I nearly keeled over.
It is simple measures like this that support practices in trouble. Not funding that comes with 20 strings attached, a training scheme that you haven’t asked for or a ‘CQC-type’ inspection. And if I can understand what is needed, then it can’t be rocket science, but it has seemed either beyond the wit – or perhaps the will – of NHS bosses to design an effective scheme to support vulnerable practices.
The next few months will be crucial
Pulse has been calling for months for funding to be released to enable those at risk of closure to continue, and we found out recently that around a quarter have been classed by NHS England as eligible for their ‘resilience’ programme.
In itself, this is an extraordinary admission for the health service to make, and sadly it vindicates all the portentous warnings Pulse has given. It is perhaps too early to hope that 2017 will finally mark the year the health service deals with the crisis in general practice, but at least this is an encouraging sign managers understand the scale of the problem.
The next few months will be crucial. All CCGs in England have been tasked with submitting a plan to NHS England before Christmas on how they will implement the GP Forward View locally. These should contain significant new funding for practices: CCGs have been told to spend £3 per patient on general practice and some will receive an additional £6 per patient from April from NHS England. We list the areas that have so far promised extra funding for general practice today.
But – as ever – it’s not so straightforward. CCG funding must be allocated for ‘practice transformational support’ (no, I don’t know what that means either) and the £6 per patient is only for those areas with ‘successful’ seven-day GP access pilots. There is a new £45m pot that could be used for new members of staff, such as care navigators or medical assistants, but it also has to be used to widen use of online GP consultations.
So what could be a shot in the arm for practices is again tied up in red tape. We can only hope CCGs are more imaginative in how they interpret this guidance than area teams and that LMCs are involved at an early stage.
And, of course, the other crunch date will be 1 April. We understand negotiations on the new GP contract for next year are continuing, but how the expected 4% increase in funding under the GP Forward View is delivered will be a major test of NHS England’s intent to stabilise general practice.
But all this may be academic for the GP I started this column with. When I asked him about his future plans, he replied with a grin: ‘Oh, I’m looking to sell up. I’ve had enough.’
Nigel Praities is editor of Pulse