Although I am sure every GP has heard of the GP Forward View many would say that they have seen little or no impact yet.
Some of the initiatives are already up and running, for example the changes to the NHS Contracts for hospitals to prevent the numerous "hand offs" to general practice. Over that last few months the LMC has written to all local Trusts and have being discussing both implementation and monitoring with CCGs. Remember this should stop hospitals asking GPs to re refer people who DNAed and appointment, to follow up results of tests ordered by hospital and reduce the need for GPs to to be the "go-between" for consultant to consultant referrals.
We have a number of practice who have received support via the Vulnerable Practice Scheme and also the Resilience programme.
The LMC is regularly meeting representative of NHS England nationally and the Area Team and CCGs locally to ensure the GPFV is not only fully implemented but also the resource invested has the maximum impact.
The CCGs all have to submit plans for implementing the GPFV by the 23rd December.
The LMC has requested details of these plans and will compare what our CCGs are planning to do.
The focus on the next year includes:
1. Transformation support – the ?171m or ?3/pt to be invested in 2017/8 and 2018/9 is designed to be used to stimulate development of at scale providers for improved access, stimulate implementation of the 10 high impact actions to free up GP time, and secure sustainability of general practice.
2. The purchasing of online consultation systems – the ?45m being made available over the next 3 years.
3. Training for care navigators and medical assistants for all practices - ?10 million will be available in 2017/8 and 2018/9.
4. GP resilience programme – a number of practices have been identified and allocated funding for 2016/7 but the focus now shifts to the investment for 2017/8.
5. Improving access to primary care - The Prime Minister's Challenge Fund site are going to continue to receive ?6/wt patients in 2017/8 and in addition the 18 transformation zones will also receive the same funding. Other areas will receive ?3.34 per wt patient from 2018/9 to allow the area to develop plans for improved access. So by 2019/20 all practices will receive this funding.
6. Estates and Transformation Fund (formerly the Primary Care Transformation Fund) - this fund of about £900m has committed funds within Wessex included some new premises and also investment in technology.
7. Increased investment into general practice - CCGs are expected to increase funding to general practice at a level that is not less than the increase in core allocation to the CCG. We are seeking clarification of what the CCG's plans are.
8. Care redesign - we have asked:
- How does the CCG plan to ensure there is sustainable general practice locally?
- What are you doing to invest in transformation into the delivery of the New Models of Care?
- How will this plans fit with your primary care strategy and with the overall Sustainability and Transformation Plan?
9. Time for Care Programme
The LMC has asked - Who is the senior leader in the CCG who has been given the responsibility for the delivery of this programme?
The LMC has also asked for further details of the CCG’s plan to support general practice by implementing:
- The 10 high impact changes - see attached document - or click here to see a short video summary. For a summary see page 52 of the GPFV.
- The Time for Care Programme - click here for more details
- The general practice leadership programme
There are some excellent examples of simple things that can help practices.
I am very privileged to work in Wessex, where we generally have high quality and innovative practices. Whenever I visit a practice I always learn something I can take back to my practice. One thing we are not so good about is sharing these experiences.
NHS England are keen to "showcase" real examples of innovation that have made a difference, especially if they are related to the 10 High Impact Changes.
- Active signposting - online portal, reception navigation
- New Consultation Types - phone, e-consultation, text and group consultations
- Reduced DNAs - easy cancellation, reminders, patient recording, read back, report attendances, reduce "just in case"
- Develop the team - minor illness Nurses, Pharmacists, Therapists, Physicians Assistants, Medical Assistants and Paramedics.
- Productive work flows - ?match capacity and demand, efficient processes, productive environments,
- Personal productivity - personal resilience, computer confidence, speed reading, touch typing
- Partnership working - productive federations, specialists, community pharmacists, community services
- Social prescribing - practice based navigators, external services
- Support self care - prevention, acute episodes and long term conditions
- Developing Quality Improvement Expertise - changed leadership, process improvement, rapid cycle change, measurement
If you have examples that you would like to share,
email me - firstname.lastname@example.org
and I will put you in touch with the national team.
In Wessex we have a population of 3,300,000 with over 3000 GPs and 500 practices, we are larger than Wales or Northern Ireland and cover over 6% of the population of England so it would be great to see over 10% of the examples being showcased coming from our area.
10. Deployment of funding for reception and clerical staff training, and online consultation systems
This funding has been allocated to CCGs and they are required to submit plans as to how this resource will be used. There is a requirement that CCGs consult with their member practice on the delivery of this programme, we are working with the CCGs to ensure this happens.
11. Workforce strategy
The CCGs have been asked to include a workforce strategy plan for their local health system that links to their service redesign plans. This should include information about the current position, areas of stress, examples of innovative practices and the planned future model and how to get there. The LMC has not only asked to see this plan but would like tower with the CCGs to ensure the maximum benefit for general practice.
As I am sure you can see with 12 CCGs to cover there is a lot of work for your LMC to undertaken on your behalf in the next few weeks and months.
5. Online consultations
The workload of a GP can be measured by surgery consultations and home visits but this excludes other important methods such as telephone consultations and more recently online consultations.
To help reduce demand and regain control of our workload we need patients to be able to access reliable help to self manage their condition and sign post patients to other services where help can be provided and the person does not need to consult with a GP.
All practices find the greatest pressure on their phone lines is between 8am and 10am. Online consultation can help reduce this pressure and it can save time for the GP.
How you may ask?
You can complete 2-3 e-Consultations in the time it takes to undertake one face to face consultation.
E-Consultation is now available in over 75% of practices in Hampshire. Some have purchased this themselves to help meet demand and many have had this funded through the Hampshire MCP.
The GP Forward View has committed to invest £45m to stimulate the uptake Online Consultations for every practice in England.
In this short video, Dr Tom Bertram, GP from Jubilee Surgery, Titchfield, Hampshire talks about eConsult and the benefits his surgery have had using it - click here.
If you want to see a Demo version - click here.
E-Consult is not the only provider of this service but is the one that is most used locally.
6. Dental problems presenting to general practice
This is an recurring problem for general practice.
Patient phones up your practice requesting an appointment to sort out their dental abscess or requesting stronger painkillers for their dental pain. They have tried their dentist but they have to wait 3 weeks for an appointment. Can this be true? Are they coming to you because if they see their dentist it will cost them and of course are appointments are free?
The other problems is how do you know it is a dental abscess until you have seen it? Occasionally there other more serious causes of swelling in the mouth.
General dental practitioners have an ethical responsibility to provide reasonable access to advice and emergency treatment for their patients, including those who are seen under a private contract. An ethical responsibility is different from a contractural one.
A dentist’s immediate responsibility for in-hours urgent dental care applies to patients who are currently undergoing or have recently completed a course of dental treatment with them. This may therefore exclude many patients who present and have not received recent treatment.
GPs should also be aware of the following legal and contractual obligations1:
- Before refusing to treat a patient asking for emergency dental treatment, a GP must ascertain that the condition requires only dental treatment. Primary care teams must put themselves in a position to judge the nature of the patient's condition by undertaking reasonable enquiries and where appropriate a clinical assessment.
- Having established an apparent dental problem, GPs or practice teams should signpost to a dentist or local emergency service or if they feel necessary refer a patient for any further assessment and treatment, to secondary care.
- Everyone in the practice team must do their best to ensure the patient doesn’t need the attention of a GP when signposting.
- If the patient has no usual dentist, or there is no response from the usual dentist, the patient should contact the local NHS 111.
- Patients presenting with signs of spreading infection or systemic involvement of a dental infection should be referred immediately to secondary care for appropriate surgical management. Signs and symptoms of this may include, diffuse or severe facial swelling, trismus, dysphagia, fever or malaise.
The BMA has recently produced some useful guidance - click here.