What did the GPC or LMC ever do for me?
Date sent: Sunday 19 November 2017
I recently attended the national conference of English LMCs, the Chair of the GPC always starts off the day with their “State of the Nation” address. This year Richard Vautrey, the Chair of GPC gave an excellent speech. During the speech, his addressed the important question of “What has the GPC done for me?” The list of achievements was quite impressive and significant and this got me thinking. How many grassroots GPs are aware of all that has been achieved in the last 2 years? Also the same question could be asked of your LMC.
I therefore thought that it was worth dedicating an email to detailing what has been achieved by the GPC as described by Richard and also describe some of the work that the LMC is currently involved in.
Clearly general practice remains in a difficult place with many challenges so what is detailed below are not enough and more needs to be done to ensure general practice remains the “Jewel in the Crown” of the NHS, a great place to work and the cornerstone of the NHS.
Your LMC is working very hard to support you and your practices and trying to find solutions to the major problems that you face, for example:
- Workforce - recruitment and retention
- Payments - or delays in them cause by Capita
- Shift of work from secondary care
- Capacity of community services to support your patients
What did the GPC ever do for me?
The GPC is often accused of not doing enough for general practices and this challenge is seen all to frequently on Social Media. As a profession, we are stronger we we are united and weaker when we disintegrate into blaming each other for the problems that face general practice.
Last week there was the National Conference for English LMCs and at the start of the conference it is customary for the Chair of the GPC to give a "State of the Nation" speech. Dr Richard Vautrey, the Chair of GPC gave an excellent speech and the full text of this can be read by clicking here.
He detailed what the GPC had done for the profession in the last couple of years.
Some of the key achievements were:
- Reversal of much of the contract imposition that took place 2013.
- Worst elements of QoF removed.
- Ending of some DESs that were bureaucratic and unpopular - such as the avoiding unplanned admissions DES.
- There is now non-discretionary maternity pay and guaranteed sickness pay - many practices have reduced their locum insurance costs significantly.
- Indemnity - the GPC secured funding to cover in-year indemnity rises and have a commitment to introduce a State Backed Indemnity Scheme by April 2019, to cover all GP staff.
- CQC fees are now funded by the NHS and not hard pressed GP practices.
- CQC inspections which were annual are now moving to 5 yearly for those practices who are good and outstanding.
- General practice has seen a decade of a falling share of the NHS budget - 2006 - 9.6% of its budget on general practice, by 2013 this had fallen to 7.4%. The GPC believe that general practice should receive 11% of the NHS budget - therefore there is still a funding gap of £2bn to get us back to 2006 levels. In the last two years the GPC have secured over £500m recurrent investment in to general practice.
- The introduction of an improved retainer scheme.
- There are improvements to the induction and returner scheme.
- Increase in medical school places with a greater emphasis on recruiting GPs for the future.
- Significant expansion of the international GP recruitment programme.
- There are promises of more nurses, both in our practices and working alongside us in our community teams, more pharmacists, an expansion of the number of mental health therapists, greater access to physio first schemes and more admin support to take away some of the unnecessary tasks that many GPs find themselves doing - but all of this needs recurrent funding to fully implement the change.
- Premises - there is a promise of £1bn capital investment, delivered through the estates and technology transformation fund (ETTF) - and there are a number of schemes in Wessex - but these are slow to progress, and many have not been able to secure funding through this scheme.
- The GP Health Service - has been introduced to help GPs especially those who are suffering from addiction, mental health problems or burn out and hundreds of GPs have already accessed the scheme.
- Changes to the Hospital contract to require Trusts to issue appropriate Fit Notes, follow up and action their tests and investigations, refer patients to another specialist when linked to the problem the patient is seeing them for rather than bouncing this back to the GP, improved discharge and OPD letters - introducing a common format, timely receipt by practices and moving to an electronic transmission method.
The NHS is seen as the one most cost effective healthcare systems in the world and the one that provided great value for money. One major reason for this is that general practice and the service that you provide. General practice is paid on average £142.63 per patient, that’s all a typical non-dispensing GMS practice gets for a year’s worth of unlimited care. That’s only 57p a day per person registered with your practice, and so is it any wonder practices up and down the country are struggling to keep the show on the road.
General practice provides a comprehensive, responsive, sustainable, free at the point of access service.
If we really are to see the vision of care closer to home realised, with far more of a patient’s care being delivered by teams working in their communities, then we need to see the investment in general practice and community based services and politicians and commissioners need to back the rhetoric with funding decisions that will make the difference to our patients lives and help us to deliver a service we know can be achieved.
Saving general practice - the latest publication from the GPC
General practice is often referred to as the cornerstone of the NHS; the foundation on which a world-renowned health service is built enabling the delivery of high quality care, free at the point of access, to the whole population. It is inherently flexible and adaptable and has always risen to meet new challenges including increasing demand, and keeping up with a steady stream of ever evolving regulatory arrangements and management system changes.
However, it has had to do this against the backdrop of an acknowledged decade of underfunding and a failure by Government to address the urgent challenges facing primary and community care services. As a result, the foundation on which the NHS sits today is cracking and can no longer withstand the weight it is expected to bear.
In response to rising pressure and growing concern over patient safety, GPs across England participated in a survey about their willingness to close patient registration lists to maintain safe workload levels. The BMA found that 54% of practices said they would be willing to temporarily suspend patient registration, whilst 44% said they would be prepared to close their list altogether.
With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice. The health and wellbeing of our nation depends upon it.
Please click here for more information.
But is this enough to change the fate of general practice?
The simple answer is no, much more is needed and I believe that the GPC is up to the challenge and is trying to achieve a better outcome for all and this will only be achieved by the GPC working closely with the RCGP and LMCs.
The question, "What did the GPC ever do for me?" deserves an answer and I hope that the paragraphs above give you some insight and what will come to most peoples minds when they have read this would be "What did my LMC ever do for me?"
What did my LMC ever do for me?
At the end of the week, I often reflect on what we have achieved during the week, and by the "we" I mean the small and dedicated group of individuals that work for Wessex LMCs which includes Dr Gareth Bryant my Deputy, Dr Laura Edwards and Dr Andy Purbrick the LMC Medical Directors, Carole Cusack, Lisa Harding and Michelle Lombardi our Directors of Primary Care, Louise Greenwood who is responsible for Wessex LeaD and Helene Irvine our Nurse Advisor. But it does not stop there, none of what we do could be achieved without the help and support of Julie Thornley our Business Manager and Lisa, Lesley, Jo, Giselle and Marie.
I am proud to lead an organisation that has done so much and achieved such a lot over the last 10 - 15 years but we must do more as there are many problems left to solve. The level of support that we get from your representatives who form the LMC Committees and from you and your practice makes a very difficult task easier and far more rewarding. But when challenged about what we do for general practice and I start to explain the depth and breadth of what we do it is clear that much of this will not be seen by most GPs and Practice Managers. I hope the details below will give you some insight into what we do for you.
As an LMC our role is to represent GPs, practices and the profession at a local level. This will include being the voice of general practice, providing leadership, supporting individuals in difficulty, working, negotiating, challenging CCGs and other bodies when issues impact on general practice. An ever increasing role is partnership working with the Local Authority, hospital trusts, community providers and anyone else who wants to work with general practice.
Perhaps the best way of answering the question, is to give you brief details of some of the things that we are involved in.
General practice is essentially provided via 3 types of contract GMS, PMS and APMS and then in addition to this practices will have local contracts (previously known as Local Enhanced Services (LESs) and national contracts called Directed Enhanced Services (DESs) and QoF.
Each contract in governed by a set of regulations and terms and conditions. The LMC spends quite a lot of time working with Commissioning Organisation to support practices and to ensure that practice contracts are fair and effective.
GP Forward View (GPFV)
An additional £2.4bn per year to support general practice in addition to an annual budget for general practice of £8bn, might at first glance seem to be the answer to our prayers, yet as a profession there has been a mixed response to the GPFV. This additional investment will only benefit general practice if the fund is new money, is invested at a local level, has impact, is recurrent and adds capacity.
This year there has been a focus on funding vulnerable practices, helping with resilience, and providing training for practice nurses, managers, practices (10 high impact changes) and to develop premises and technology through the Estates Technology Transformation Fund (ETTF).
There has also been the introduction of the GP Health Service.
The LMC has been working with NHS England and CCGs to ensure this investment achieves the maximum impact and really gets to the front line.
Transformation at practice level and the support to work at scale - this is the £3/patient or £171m nationally that CCGs must invest over a 2 year period to support general practice and provide help to work in a different way. The LMC is engaging with each CCG and comparing not only the level of investment but also what the investments means to GPs, Practices and patients.
Workforce - we need more doctors, GPs, nurses and other healthcare professionals to support us.
The Government are investing in several new medical schools and expanding the number of medical students in some existing medical schools with a particular emphasis on those who have a programme more focused towards general practice. The LMC has been actively involved in these discussions locally.
GPs - GP Training is critical to our future. The LMC works closely with the Deanery to support GP Training both in Wessex and Severn. The LMC normally will have a session at the day release course which has always proved very popular.
Nurses - the LMC has been working with Health Education England (HEE) to support the placements of undergraduate nurses in practices and ensure they are funded for this.
MSK - in my practice we worked with our Community provider to test having a MSK Consultant (Physiotherapist by training) based in the practice offering appointments booked directly by patients or the practice. He worked as part of the practice team. The evaluation has shown this is a cost effective model and is well liked by patients, it adds some capacity to the practice but also has been shown to reduce the number of investigations, referrals and prescribing costs. This work has played a significant part in supporting national discussions to implement a similar service across the country.
Pharmacists - the LMC has supported the introduction of pharmacists as members of the practice team but remained concerned that the national scheme means that the full cost of the pharmacists falls on to practices. The project in West Hampshire CCG, supported by the LMC, has placed pharmacists in practices who are part of the CCG medicines optimisation team but with additional fund the team has been significantly expanded so that a pharmacist is based in a practice for 2-3 days a week and works for the practice on initiatives as diverse and discharge medication, polypharmacy, nursing homes, working with community pharmacists, managing long term conditions and expanding electronic prescribing.
Mental Health Workers - we are expecting 3,000 of these professionals, pilots are taking place across the country but not in Wessex. These are essentially IAPT services based in a locality. The LMC would like to see the work with mental health taken much further to include having CPNs as part of the practice team.
Physicians Associates - there is still lots of confusion here about what this role means. There is one Physicians Associate working in Wessex and the LMC has been working with HEE to develop a local University based programme.
This occupies much of our time and by the very nature of this will not be seen by you unless you are one of the people who seek help. We often will help, support and advise individuals on a range of subject, particularly when this relates to performance, health of conflict. We can work with individuals or practices but also have a network of other organisations who can provide help.
The LMC is currently reviewing how the support that is offered can be developed and improved.
Wessex Insight was an initiative developed some years ago by the LMC working with Wessex Deanery and has helped a number of GPs. It can provide mentoring and other services to GPs and is partially funded by the LMC - click here for more details.
The introduction of the GP Health Programme, although a national initiative has local support from the LMC and is focusing on mental health and addiction is a positive development and being well used locally - click here for more details.
Please see the attached booklet which details more about what we do to support GPs and helps to explain the bodies that are involved with performance issues.
This is a vital part of our role and includes a range of methods from email, telephone, individual face to face meetings, group meetings and conferences.
As individuals and as a group we receive and reply to a huge number of queries on a daily basis. I hope that my email updates are useful and the Directors of Primary Care also produce one for Practice Managers.
Practice Manager forums are present in most areas and we try to attend as many of these as we can.
Speaking at conferences whether they are organised by the LMC or other bodies remains as an important part of our role. In the last year we have held a number of very successful conferences ranging fro the recent Annual LMC Conference to two Practice Manager Conferences, a Learning Disability update, a Cardio-vascular Conference and at the end of November there is a Wessex Mental Health day - each of these events have or will be attended by between 120 - 200 delegates all with very positive feedback.
Education and training
This is not a core function of the LMC but we felt there was a need to ensure that there was high quality education and training available at an affordable price that was easily accessible and relevant to general practice and that there was some sort of quality control. The emphasis being on Practice Managers, Practices Nurses and Administrative Staff, which were the areas that we identified as having the most need.
Recently we have held a number of CQC Training Events which have proved very popular.
About 5 years ago the LMC established Wessex LeaD and under the leadership of Louise Greenwood this has grown from strength to strength and has achieve not only a great local reputation but is also recognised nationally by developing programmes that are now being adopted by others, securing national funding for piloting programmes and winning national awards.
There are currently 129 courses to chose from and available for online booking - click here .
This link will also take you to our "Lunch and Learn" resources that range from Information Governance, Dementia, Mental Capacity, Safeguarding, Sepsis, emergencies in general practice to name but a few. The Sepsis lunch and learn has recently been added and results for collaborative work undertaken with local and national experts in the area.
Revalidation and appraisals are important for GPs and the LMC has worked with Fourteen Fish to develop an Appraisal toolkit for GPs with easy to use Multi Source Feedback (MSF) and Patient Specific Feedback (PSQ), which are now widely used locally and across the country. Nurse appraisals are slowly being introduced and Practice Manager peer appraisals are seen as being a positive development that has occurred as a result of the work we undertook on behalf of GPs. So there is now an appraisal toolkit with MSFs for Nurses as well as Practice Managers.
With the potential loss of GP Tutors in Wessex, the LMC is working closely with the Wessex GP Education Trust and other parties to ensure that GP education is delivered locally, by a variety of means and remains relevant and readily available.
The NHS is moving away from choice and competition and essentially a market driven service to one where partnership working is becoming increasingly important. The NHS has become too reliant on hospital based care with a disproportionate amount of the total budget being committed to hospitals resulting in the lack of investment in mental health, community services and general practice. To achieve a better balance there needs to be a strong GP voice, speaking up for our profession and practices. This has resulted in more and more organisations not only wanting to meet with the LMC but also form a closer working relationship.
The LMC meets with all CCGs and NHS England on a regular basis. These meetings address both strategic and operational issues.
The LMC also works closely with for example local hospital, the Local Authorities, Health Education England (HEE), the three STPs (Sustainability and Transformation Partnerships) in our area, the Local Delivery Boards (established in Hampshire).
General Practice is unique in the NHS because of our contractual arrangements and this means that within Wessex there are not only 500 practices but there are 500 small businesses. There are therefore a unique set of requirements placed on some GPs which include partnerships, employing staff, premises (whether owner of lease holders), managing complex contracts with the financial consequence of those. As a result of these factors practices will often need to take professional advice from Lawyers, Accountants and Surveyors. The LMC can offer a wide range of advice but in these specific areas it is important that practices can access specialists who have a full understanding of general practice.
Some years ago the LMC set up a regular forum for discussion called “the Medical Lunch Club” and invited local Solicitors, Accountants and Surveyors to meet with the LMC on a quarterly basis. These meeting are really productive allowing a full range of debate and discussion on a wide range of issues. The benefits are not only everyone learning from the contribution of other but has formed a strong network where advice can be sought and most importantly trusted.
Wessex LMCs developed a quick and easy to use Healthcheck Tool for practices. The tool has been endorsed by the RCGP (who are also now available to offer facilitation for both the diagnostic stage and a menu of options to take forward action plans for practices, particularly those within the resilience programme) and by NHS England who will be publishing the tool on its own website for use by practices nationally.
“Each practice is just one retirement / resignation away from crisis”
This Lunch and Learn training resource is unique to our other resources in that it does not provide any answers – but has a diagnostic tool at its centre to help you look in detail at the health of your practice now and in the future
Without wishing to reiterate the crisis facing general practice at present, we are well aware that practices are facing extremely difficult times. To this end, Wessex LMCs have developed this diagnostic tool which practices may use to help them identify where on the spectrum of vulnerability they lie which may prompt practices to take proactive preventative steps to avoid reaching crisis point
The diagnostic tool will enable practices to identify key issues to address and will signpost the practices to some possible solutions. Click here to access the toolkit.
It is important that the LMC is not only seen as the local representative body for all GPs but it shows leadership and works with various NHS and non NHS Bodies to promote, support, protect and develop general practice in the broadest sense. To have any degree of influence and power as an individual or organisation you have to be known, respected and your views be listened to. It is easy to be confrontational and fight battles but more difficult to find solutions and create a better future for those that you represent and some of the time you have to accept that the most you can do in certain situations is to prevent something happening that would be detrimental to GPs or practices (this is an important part of our role and one that by the very nature of it is not often seen or recognised).
Next Generation GP programme
It is vital that we provide support and opportunity for the next generation of leaders. The LMC has supported a national programme called the Next generation GP programme, and because of the success of this programme a similar one has been launched in Wessex. We have close to 70 young GPs who are going to be involved over the next 6 months. For more information - click here .
Capita – Primary Care Support England (PCSE)
To be able to deliver general practice effectively there are many components but three important ones are:
- Having a workforce – for GPs they need to be on the performers list
- Having clinical records
- Being paid for delivering a service
General practice has suffered from a failure in all three areas. Capita was awarded a contract and were expected to deliver a service that included maintaining the performers list (this includes new entries as well and retaining those who are on it), moving clinical records between practices when patients move practices and also for a system of paying practices or deducting money for pensions etc.
Over the last 18 months most practices and GPs have been effected in one of these areas, whether that is difficulty in getting on the performers list, inadvertently being removed, clinical records taking far too long to be transferred, payments for trainees not being made and pension deductions for salaried GPs not being take and/or incorrect sum being taken (this names but a few).
The LMC has been working with CCGs, NHS England, HEE and Capita to try and resolve the difficulties ASAP. We believe most of the issues with the performers list and notes transfers have been resolved. Progress is being made on the payments to practices but this is too slow and it is unacceptable that practices are having to wait months for payments that are due. The LMC is continuing to put pressure on those responsible to resolve this situation.
Pensions - there has been considerable problems with Capita not taking the correct pension contributions, particularly for new GPs working in practices whether they are partners, salaried GPs or trainees. The LMC has been working closely with practices and Captia to resolve these issues.
Locums - many locums have also been affected by the pensions issue and sought the LMC's help, many of these GPs have not been members of the LMC as they did not think membership of the LMC was important for them. We would encourage all GPs to be members of the LMC, if you are a partner in a practice or a salaried GP working in a practices then you are a member as the practice pays an annual levy. All we ask is that locums pay an annual fee of £50 which is tax deductibleclick here - if you are a locum and not a member and reading this email, perhaps you should consider joining! for more information.
Practice Manager Supporters
What always impresses me is the dedication, quality and enthusiasm that exists in our Practice Managers. As GPs, I really do not believe that we give enough credit to Practice Managers. They are one of our most valuable resources, and their commitment and determination needs to be recognised by us all.
Ten PM Supporters have now been recruited to support our Practice Managers. The PM Supporters are put in touch with a new PM when they arrive in their job, can be contacted about CQRS, their role in a merger, or as a sounding board for general advice and to prioritise their workload. They are also trained to run peer appraisals on their colleagues. Wessex LMCs funds up to two sessions per month for each PM Supporter as the work they do with PMs assists the whole primary care team.
When practices lose experienced GPs and find it difficult to recruit new GPs employing a locum for set sessions is often not enough. The responsibility of the practice then sits with less people which increases the pressure further. This can lead to a downward spiral and is a factor that contributes to the failure to recruit.
The LMC is in the process of developing a small team of experienced GPs who could help and support practices.
Practice Manager Appraisals
We are delighted that our scheme of running appraisals for practice managers has been recognised and is now being rolled out nationally. It is easy to forget that there is no national body to support PMs, no register and no official qualification to work as a PM. However, their knowledge and personal development is crucial for their own self motivation and can be vital for the health and wellbeing of the whole practice.
Please read what one PM said:
“I felt pretty daunted before my appraisal, maybe because of all that I have on my plate. But I cannot thank you enough. It was just what I needed to challenge my train of thought and to guide me, reinforce what I know I need to do to help ease the pressure and what goals I need to set to make for a better work life balance. I will definitely be looking to do this next year to see if I have achieved the goals set.”
Documents to help and support GPs and Practices.
Below are some specific documents that have been produced recently by the LMC which you may find helpful.
Ear care - click here to download.
The Healthy Leg Club concept - click here to download.
Support for GPs - the document is attached
All of the above will continue with some new work streams including for example Freedom to Speak up Guardian, GDPR and Data Protection, Non-Medical prescribers advice.
Please email email@example.com with any suggestions for workshops/conferences or priority issues you would like us to consider working on.
I hope this gives you an insight into the work done on your behalf.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)
Attached file: DOC-0129 Support for GPs - What is available Nov17 v2.pdf