Building the New Deal:Why, what and how?

The future for English General Practice

Dr Tim Ballard FRCGP

Vice Chair of Council

RCGP

Overview

• 10 years under-investment in general practice

• Failure to develop the workforce in general practice

• The Five year Forward View – Building the New Deal

• Building the workforce – the 10 point plan

• Why - are we where we are?

The wider picture

• Shipman

• The 2004 Contract

• Sustainability & Austerity

• Changing Demography

• The personalised Society

• The Health & Social Care Act 2012

• What - are the other pressures for

change?

• A Call to Action (NHSE)

• The Future Hospital Report (RCP)

• The Dalton Review

• The Urgent & Emergency Care Review

• What - are the pressures for change?

• Specialised Services in OOH Settings

• The Oldham Report

• Chen – Med & Segmentation of Primary Care

• General Practice Delivered at Scale (NHSE)

• CQC

English

General Practice

today

• Around 1.2m patients seen every working

day – increasing complexity

• 340-370 million consultations per year

(300m in 2008)

• Increase in workload, static funding and

falling resource is bringing general practice

to its knees

Funding of

UK general practice

General practice funding has fallen by 8% across Britain in real terms since 2005/06 – at a time when the rest of the NHS budget has grown by 18%

Source: RCGP analysis

Rising Demand

Between 1995 and 2008, the number of consultations in General Practice rose by 75% to

more than 300m. A sharp increase in consultations for those over 65 has contributed to this

Not enough GPs: The general practice workforce crisis

The rise in numbers

and complexity

“Epidemiology of Multimorbidity” – Lancet, May 2012

“Epidemiology of Multimorbidity”

Lancet, May 2012

• Set up by Secretary of State

• Target for GP training numbers

in England to be 3250 per annum

– 50% of Graduates

• Target missed 6 consecutive years. Around 2700

recruited annually

• 2014 – 2564, lowest number since 2007

• Also worsening retention – GPs nearing

retirement; young women

General Practice Taskforce

• Three strands to this plan

• Improving recruitment into general practice

• Retaining doctors within general practice

• Supporting those who wish to return to general

practice

Building the workforce

the 10 point plan

• Major promotion of general practice

– the first ever RCGP national recruitment video

launched last Saturday.

• Widespread

coverage across

all media

• Over 7,000 views

in less than a

week

Recruitment

• Improving breadth of training. Opportunities for

additional training in areas where it is hard to

recruit (clinical, leadership, academic)

• Training hubs – groups of

practices, multi-professional

training

• Targeted support. Additional financial incentives

in under-doctored areas

• Improved retainer scheme, meeting needs of retainers

and practices

• Improving training capacity in

practices – including investment

in infrastructure

• Incentives to remain in practice (funded mentorship

scheme, access to portfolio career, clearer range of

career pathways)

• New ways of working (pharmacists, medical

assistants, physicians assistants, care navigators)

Retention

• Safe, proportionate route to return to

practice

• Targeted investment in returners. For

areas of greatest need, resources to help

with cost of returners and employment of

returners

Return to Practice

• Puts a strengthened primary care at the centre of its vision for the

NHS, based on building a ‘new deal’ for general practice

• States clearly that more of the NHS budget will be invested in

primary care

• NHS England will work to increase GP recruitment

• Puts general practice at the heart of new models of care –

particularly the Multispecialty Community Provider model.

• Backed by funding announced in the Autumn Statement – including

a fund of over £1bn for GP premises

• Commitments wouldn’t have happened without pressure from the

College and others

• Established by HEE following announcement by

SoS at RCGP conference

• Chaired by Prof Martin Roland

• Prof Amanda Howe is one of the commissioners

• Identify models of primary care to meet needs of

future NHS

• Highlight good examples of integrated, patient

focused ‘out-of-hospital’ care

• Report by end of June 2015

Primary Care Workforce Commission

• How can the Profession Respond?

• 2022 - A Vision for General Practice (RCGP)

• The inquiry into Patient Centred Care

(RCGP)

• Put Patients First Campaign (RCGP)

• Your GP Cares (BMA)

• How - do we know we are making progress?

• The Labour Party Conference

• The Conservative Party Conference

• The RCGP Conference

• How – should the profession respond?

• A salaried service – APMS and private

providers?

• Vertical integration or Integrated Care

Organisations?

• Independent contractor status?

• How – should the profession respond?

• Networks and Federations, Networks and Federations, Networks and Federations,

Networks and Federations, Networks and Federations, Networks and Federations,

Networks and Federations, Networks and Federations, Networks and Federations,

Networks and Federations

• Why – are Federations & Networks part of the

answer?

• Enable Professional Control

• Keep the traditional patient facing feel of GP

• Demonstrate the will to tackle variability

• Control Segmentation

• Control the way we work with Secondary Care

• Why – are Federations & Networks part of the

answer?

• The 5 Year Forward View

• Multiprofessional Community Partnerships

(MCPs)

• Primary & Community

Services (PACs)

• How – do we organise ourselves?

• The Use of Co-Commissioning

• The Whole systems Integrated Care Toolkit

• RCGP Clinical Commissioning Workshop on

Feb 26th

• New Models of Care – Design Principles

• Based around the Registered List

• The centrality of relational care

• Driven by Primary Care

• New Models of Care – Examples :

External

• Dermatology

• Diabetes

• Care of the Elderly

• SPA Schemes

• New Models of Care – Examples :

Internal

• Doctor First

• Online Access

• Pathology Services

• Near Patient testing

• Medical Assistants

To meet the challenges

We need to build a new deal:

Workforce - Premises – Resources-New Models of

Care