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Primary Care Scrutiny under the Five Year Forward View – Part 3: Funding & Commissioning
The House of Commons health committee recently launched an inquiry into primary care which includes scrutiny of GP pay and workload. The inquiry, which launched at the end of July, will also look at issues including GP recruitment, patient access and the future models of general practice described in the Five Year Forward View. It will look to review:
- The quality and standards of care for patients
- Demand and access (including out-of-hours access and proposals for seven-day access)
- Funding (including local and national distribution of resourcing)
- Future models of care, as piloted by vanguards
- Workforce: current and future challenges (including recruitment, retention, training, skill mix, contractual models, workload and pay)
Announcing the inquiry, which will look at the evidence later this year, the committee said: ‘The aim is to consider whether the Department of Health and its arms’ length bodies have the plans and policies in place now to ensure that high quality care is consistently available to patients at the point of need.’
This article, the final in a series of three, will address the last two areas about vanguards and workforce and what they mean for Practices.
New care models – vanguards
In January 2015, the NHS invited individual organisations and partnerships to apply to become ‘vanguard’ sites for the new care models programme, one of the first steps towards delivering the Five Year Forward View and supporting improvement and integration of services. In March, the first wave of 29 vanguard sites were chosen. There were three vanguard types:
- Integrated primary and acute care systems
- Enhanced health in care homes
- Multispecialty community providers
In July, a second wave of eight vanguards was announced, known as urgent and emergency care vanguards. 37 vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representative groups. Each vanguard site will take a lead on the development of new care models which will act as the blueprints for the NHS moving forward and the inspiration to the rest of the health and care system. A further wave of vanguards will be announced in the autumn known as acute care collaborations, they aim to link local hospitals together to improve their clinical and financial viability.
What does this mean?
For patients, through the new care models programme, complete redesign of whole health and care systems are being considered. This could mean fewer trips to hospitals, with cancer and dementia specialists holding clinics in local surgeries, having one point of call for family doctors, community nurses, social and mental health services, or access to blood tests, dialysis or even chemotherapy closer to home. It will also join up the often confusing array of A&E, GP out of hours, minor injuries clinics, ambulance services and 111 so that patients know where they can get urgent help easily and effectively, seven days a week.
For partners the new care model vanguards are a key element within the Five Year Forward View which is a partnership between NHS England, the CQC, Health Education England, Monitor, the NHS Trust Development Authority, Public Health England and NICE.
Workforce – the current challenges
GPs and practices are under unprecedented pressure. There is now a large and increasing gulf between the workload demands on practices and their capacity to deliver essential services to their registered patients. In a recent BMA Tracker survey, 74% of GPs described their workload as unmanageable or unsustainable, which is significantly higher than any other category of doctor. In this climate, it is crucial that the safe provision of core services to patients remain GPs overriding core priority.
Practices are often being asked to carry out unnecessary work, such as following up test results ordered in hospitals which are the responsibility of the requesting clinician, wound care management (including dressings and suture removal for procedures performed outside the practice) that should be delivered by the commissioned community nursing service, and minor injury services that should be delivered by the appropriately commissioned service. This all wastes much needed GP appointments for those who really need them, often causing delays for patients. Some of this work needs to be commissioned appropriately to avoid patients experiencing any difficulty.
Workforce – the future challenges
There are growing workload demands on GP practices which are either inappropriate, or outside a practice’s capability or competence and which should be delivered by a more appropriate provider. Practices are encouraged to consider different ways of using staff to manage workload, assessing skill mix and efficient use of allied resources. There is real potential for practices to reduce workload and bureaucratic burden by working with other local practices in networks and collaboration, or if appropriate in formal mergers of partnerships or practices. Practices need to consider how they can support each other, including in practical terms, for example if a practice is experiencing severe staff shortages.
Enhanced services provide an opportunity to fund additional work and services in the community, and fall outside the contractual work of GPs. They also ensure practices are provided with the necessary resources to increase their capacity to be able to deliver this additional work. However, provision of enhanced services is entirely at the practice’s discretion and are therefore not essential services, provision is voluntary for practices. Practices must decide whether they should take on an enhanced service, as well as ensure that they are being properly resourced to deliver patient care as part of this provision.
The BMA has produced some guidance for practices which is not about restricting GP services. It is about providing safe, quality and accessible care to patients, at a time when GPs are being prevented from doing so by excessive and inappropriate or un-resourced work, which is taking them away from their prime duty of care as GPs.
Alison Lowerson – QCS Expert GP Practice Manager Contributor