The GP partnership review and what does the LMC do for you?
Date sent: Sunday 13 May 2018
Simon Stevens the Chief Executive of NHS England said in 2016: “GPs are by far the largest branch of British medicine, and as a recent British Medical Journal headline put it – if general practice fails, the whole NHS fails. So if anyone ten years ago had said: “Here’s what the NHS should now do – cut the share of funding for primary care and grow the number of hospital specialists three times faster than GPs”, they’d have been laughed out of court.
Over the two years since the GP Forward View was published, some practices have see things improving in terms of recruitment and retention but in some areas the problems have not changed.
In February 2018 the Secretary of State for Health and Social Care announced that there would be a review of the Partnership model of General Practice.
Last week the Department of Health and Social Care announced that the Chair appointed to lead independent review into GP Partnership model had been appointed - click here for the Press release which starts with - 'Dr Nigel Watson has been appointed chair of the independent review into the GP partnership model'.
My appointment was supported by NHS England, the Department of Health and Social Care, the RCGP and the GPC. The task ahead is to review current partnership model of General Practice, to consider how to reinvigorate it and equip it to help lead the transformation of General Practice for the future.
The review will consider and make recommendations related to the current challenges faced by General Practice, within the context of General Practice and the wider NHS. The review will also explore the benefits and shortcomings of the partnership model for patients, partners, salaried GPs, locum GPs, broader practice staff (practice nurses etc) and the wider NHS. It will also consider how best to reinvigorate the partnership model to equip it to help the transformation of general practice, benefiting patients and staff including GPs.
The aim is to produce a report with recommendation by the end of the year.
I would hope that during the course of the review some recommendations that emerge may be implemented before we complete the task at hand.
My practice have been very supportive and allowed me to take a sabbatical until the end of the year in order to commit a substantial amount of time to leading the review.
I will also need your help and support.
Identifying the problems is relatively easy and I am sure if I asked any GP or Practice Manager, what the top 5 problems were in terms of the partnership model there would be general consistency. Finding solutions will be the most important part of this work.
So if you have solutions to the problems we face please let me know.
The solutions will need to be focused, affordable and practical.
What does the LMC do to support General Practice?
Local Medical Committees are the statutory bodies with rights and responsibilities defined by Acts of Parliament. They represent local GPs with democratically elected members and are independent as they are funded by GPs to support GPs, practices and the wider profession.
Wessex LMCs covers a population of about 3,700,000 in Bath & NE Somerset, Dorset, Hampshire & IoW, Swindon and Wiltshire, and we also support the GPs working in the Channel Islands. The LMC covers over 450 Practices and about 3,000 GPs.
No one can deny that over the last 3-4 years general practice has had an extremely difficult time. This has been cause by a population that is growing, with an aging population, increasing demand from more people with one or more long term conditions and more frail elderly patients with complex morbidity. At the same time the demands on general practice has increased because of the pressures in the social care market and hospitals and community providers pushing more and more work away from themselves and towards general practice.
The result of this has been more GPs leaving the profession and less joining, so recruitment and retention become a major problem in many areas. Confidence in the partnership model of general practice falls, with concerns that the risk held by partners is becoming too great especially with the potential of the 'last man standing' holding all the risk.
What does the LMC do for you?
As an organisation we spend a lot of time supporting and helping individual GPs, Practice Manager or Practice Nurses. This will often fall into three distinct areas, namely, health, performance and disputes with their practice or colleagues. Our goal is to help, support, resolve or sign post individuals always looking to find a positive outcome to the situation.
Our offer to GPs via the Medical Directors and Wessex Insight is in the process of being reviewed and I hope to provide you with the details of a better offer from us to you in the Autumn.
The LMC successful bid for national funding to secure of a number of experienced GPs who would be available to help and support struggling practices. The aim is that they could provide some clinical work but also look at the practice holistically and help to find ways for practices to grow and thrive again. Click here for more information.
Rudyard Kipling said - Words are, of course, the most powerful drug used by mankind. In essence this is why we try and provide you with information help and support via our website, emails such as this and locally based meeting.
I hope you find the emails informative, we know they are read widely and shared extensively outside Wessex.
The Wessex LMCs website is a good place to look for help and information - www.wessexlmcs.com.
Education and Training
The LMC has always believed that it was essential to have locally based, good quality education and training that was offered at an affordable price. This is equally important for Practice Managers, Nurses and other staff as it is for GPs. This is why the LMC set up Wessex LEaD - click here for more information.
The LMC now offers a huge range of events for Practice Staff, all of which are directly bookable through the LMC's website. Louise Greenwood as the Wessex LEaD Manager has done a fantastic job developing this part of our organisation.
We have also produced a number of 'Lunch and Learns' where we provide you with a Presentation plus supporting materials and you can use this in your practice to support discussion and learning, these are available via the LMC's website.
The LMC has also worked closely with Fourteen Fish to produce useful tools for GPs, Practice Managers and Nurses to help with Appraisal and Revalidation.
Finally the LMC has been working with the Wessex GP Education Trust (WGPET) to develop GP education.
I am pleased to announce that we have appointed Dr Helen O'Reilly as the LEaD GP for Wessex LMCs using an Education Grant from WGPET, she will commence her new role on the 4th June 2018.
Each year we hold and annual event in November and two Practice Manager Conferences, all of which are well supported with high attendance numbers. The LMC, depending on demand and need hold a number of other conferences. This has included conferences focused on:
- Mental Health
- Learning Disabilities
- Cardiovascular disease
- GP Contracts
I do not need to tell any GP that having a great Practice Manager is vital to having a successful Practice. The LMC has always believed that Practice Managers are an important group that we need to support and work with closely.
How do we support our Practice Managers?
1. The LMC appointed 3 Directors of Primary Care, two of whom have been Practice Managers and all of whom have worked as part of PCTs and or CCGs. They therefore have a deep understanding of all the issues related to Practice Managers. They regularly attend local Practice Manager Forums offering help, advice, information and support.
2. Regular newsletters focused on issues related to Practice Management - click here to see the sort of information we send out.
3. PM Conference - that are two per year arranged by the LMC and about 250 PMs attend these informative 1 day events. This means that over 50% of our Practice Managers attend these events.
4. PM Training - in addition to the normal events organised by Wessex LEaD, the LMC has been successful in bidding for national funding through the GPFV to provide a programme for Practice ~ Managers in terms of Leadership and Development.
5. PM supporters - provide ad hoc advice and support to their practice manager colleagues, and offer learning opportunities to support Continuous Professional Development for PMs. The nine PM Supporters, offer coaching and mentoring to new and experienced practice managers, and have specific training to enable them to appraise fellow practice managers. They offer support in person, via email or on the telephone. Each PM Supported is funded for a small amount of time per month by the LMC. Click here for more details.
There is a risk that when there is a focus on workforce, we look at new roles that can be undertaken by Paramedics, Physicians Assistants, Mental Health workers etc and forget our Practice Nurses. The traditional role of a single Practice Nurse working with GPs has evolved and changed, where we now have a team which might range from an HCA, to a Nurse and maybe an Advanced Nurse Practitioner who is a prescriber.
The LMC's Practice Nurse advisor, Helene Irvine works for the LMC two days a week.
Helene has produced some excellent newsletters and is working with a number of bodies to support nurses and also aid their development and support.
The LMC is committed to develop this support further.
GPs in Training
This is an important time in our career, where we are learning the art of being a GP and also understanding the complex world in The LMC attends all the half day release courses locally for a session to present to the GP Trainees about the work of the LMC, what we do and why we are important to them. It is also a chance to talk about the wider issues faced by General Practice.
Next generation GP Leaders
Wessex LMCs has always been a strong supporter of having balanced representation. Over quite a long period of time we have worked to ensure our Committees are not just representative of the older generation of GPs and we have successfully recruited a range of GMS and PMS GPs working as Partners, Salaried GPs, Locums and OOHs GPs. There is also now a very good spread of both ages and male and female GPs in all the LMC Commitees.
Supporting and encouraging future leaders is important and I have been pleased to add the support of the LMC to Next Generations GP Leaders Programme - click here for more information - this programme started in London and we supported two young Wessex GPs to attend this. We then worked with the organiser, Dr Nish Manek, to introduce a series of events in Wessex and the first programme has just been completed. We were the first area outside London to have this programme. About 60 young aspiring GP leaders have been attending these events. For those who are sceptical about the future, I can assure you we have some great local GP leaders for the future and the LMC intends to work with others to support them and offer opportunities wherever we can.
This follows on nicely from the previous section about Next Generation GP Leaders. The LMC has been successful in bidding for national funding for a GP Fellow to work with the LMC for a year to help support and develop their leadership skills.
In fact we have been able to fund 3 posts, each for 2 days a week for a year.
We are currently looking to recruit, initially from the Next Generation of GP Leaders Group and hope to complete this process by the end of the month.
Disclosure and Barring Service (DBS) Checks
The LMC provides this as a service to our practices. We thought after the initial flurry of requests that this work would decrease but that has not been the case.
For more information about the service we offer to practices - click here.
New Models of Care, Vanguards, ACOs, ACSs and ICSs
Are you confused by all these terms and do they seem to be irrelevant to you?
The Vanguard was an initiative that came out of the Five Year Forward View. The proposal in 2014 was to establish a number of sites that would test out 'New Models of Care' and look at the needs of populations with providers working together rather than retaining the working in silos with a system whereby hospitals were paid on an activity bases and others via a capitation. The two models proposed were the Multiple Community Provider (MCP) or the Primary and Acute Care System (PACS).
The LMC was actively involved in working with and leading the MCP in Hampshire, with the aim of exploring the potential benefits to general practice and our patients. We know the challenges to practices include workload, capacity, complexity, recruitment and retention and lack of integration with community staff and social care. The purpose of being actively involved with these initiatives have been to seek solutions that would help and support GPs and Practices.
Accountable Care Systems (ACSs), Accountable Care Organisations and Integrated Care Systems (ICS) are all developed from the principle of providers working together for the benefit of patients. All these offer opportunities and also threats, our aim is to maximise the opportunities and minimise the threats.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)