GPs CRISIS

PM’S SEVEN-DAY GP ACCESS SCHEMES YET TO START

From the FMS Global News Desk of Jeanne Hambleton                PULSE  TODAY 12 September 2014 | By Sally Nash

Please note: this story was updated at 12:00pm on 12 September to include NHS England’s comments

Exclusive The Government’s £50m flagship scheme to open surgeries seven days a week have barely begun five months into the year, despite the fact they are only to be funded for one year, Pulse can reveal.

A Pulse investigation has discovered that five of the seven pilot areas contacted had not yet started their schemes, which are being funded by the Prime Minister’s £50m ‘Challenge Fund’, which was announced in a blaze of publicity at the 2013 Conservative Party conference.

This is despite NHS England originally saying they should start to go live in May, while the funding is set to run out in April.

GP leaders said that the fact they are not starting halfway through the year shows that the scheme was ‘a political gimmick’.

Pulse has learnt that the projects in north west London, Southwark, North Yorkshire, Darlington and south west England have not yet begun. The schemes in Herefordshire and Slough were the only ones able to say they have started.

There are 20 schemes across the country, which were unveiled by NHS England in April and will cover over 1,100 practices and 7.5 million patients

NHS England had offered assurances that all the pilots would start planning immediately but that patients in some areas ‘should start to see positive changes to services from May onwards’.

The funding is intended for one year only, ending in April, after which the schemes are meant to become self-sustaining.

However, Pulse has discovered that many schemes have not yet started:

  • NHS Hambleton, Richmondshire and Whitby CCG,  which was awarded £2,481,000, to extend opening hours to 8am to 8pm seven days a week, is ‘still in the planning stages’ and the pilot will start ‘fairly soon, perhaps in the next quarter’;
  • In Darlington, which was awarded £448,400, the start date for the trials is 1 October, when 11 practices will be offering evening and weekend appointments through ‘multi-disciplinary teams’;
  • A spokesperson for NHS England admitted that most of the pilot schemes in Devon, Cornwall and the Isles of Scilly – which were awarded £3.5m to ‘make services more accessible’ – ‘haven’t started yet’;
  • Two of the schemes in London – in Southwark and north west London – are both in the process of launching.

In Herefordshire, where GP consortium Taurus Healthcare and NHS Herefordshire CCG were awarded £2,663,206, the scheme has now started.

Taurus Healthcare managing director Graeme Cleland said that ‘in the first two weeks the uptake was very low’, but he was confident that demand will grow as capacity builds.

‘The demand is there, we have been sorting out the bugs and ironing things out as with any new service,’ said Cleland.

He added that patient satisfaction levels so far have been ‘excellent’ and feedback from clinical practitioners has also been ‘really good’.

In Slough the pilot project, which was awarded £2,950,000, started at the beginning of July and seven-day access with extended hours was fully implemented in August. The new hours are opening until 8pm Monday-Friday and 9am-5pm opening on Saturday and Sunday.

A spokesperson for Slough CCG described the move as ‘very popular and well subscribed’.

Concerns had been raised that the funding is only in place for one year and, in some cases, pays participating practices a sum of less than £3 a patient.

Some primary care academics have even gone as far as warning that the trend for extending opening hours could compromise patient care.

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, said that the fact that many pilots have not started yet confirmed his belief that the Challenge Fund was a complete ‘political gimmick’.

‘Here we are, nearly half way through the year of the pilots – if nothing is happening then it puts some of these pilots at risk. We do not need these one-off soundbites, for the benefit of politicians rather than patients, but proper long-term recurrent investment.’

A spokesperson for NHS England, said: ‘All the pilots are now underway and patients are starting to see benefits. Since the pilots were selected we have been working hard to get them fully mobilised, developing areas such IT, and to allow for this, some of the pilots will now continue beyond March 2015. This will enable a final evaluation of the schemes in summer next year (2015), so we can spread learning and innovation across all practices in England.’

 

GPS TO BE OFFERED OVERSEAS PLACEMENTS AND MBA FUNDING IN BID TO ALLEVIATE RECRUITMENT CRISIS

From the FMS Global News Desk of Jeanne Hambleton Sept.11 2014                                      Pulse Today by Sally Nash

 

GPs are being offered the chance to go on six-month overseas sabbaticals and given funding to undertake MBAs in leadership as part of a CCG’s radical bid to tackle the recruitment crisis.

NHS Hull CCG has designed a package of incentives aimed at keeping GPs in the area for six years and longer because it has been particularly hit by the recruitment crisis engulfing the whole of the country.

As part of the package, the CCG will find overseas placements for trainee and qualified GPs, will fund MBA or a Masters degrees in education or leadership and will give GPs the opportunity to work in different practices.

In return, GPs will be expected to work in Hull for six years, with a hope that they will remain locally after the end of the six years.

In Yorkshire and Humber, only 78% of training positions were filled this year, the third lowest in the country.

GP Dr Mike Holmes, who is associate medical director at the CCG, told Pulse: ‘It is no secret that recruitment has been difficult in Hull which is an under-doctored area. We hope that we have put together an attractive package.’

The six years period will help with retention, Dr Holmes said, and enable GPs to get to grips with local issues and form a longstanding relationship with patients.

The sabbatical element of the package is something that Holmes ‘has not come across before’ and will enable doctors to bring experience gained abroad back to the UK to benefit patients here.

If the recruitment process proves successful it will be repeated next year, he added.

Earlier this year, Pulse revealed that health education bosses have overseen the worst GP recruitment round for seven years.

A report from a taskforce on the training crisis recommended radical solutions such as capping the number of training places available.

Along with GP trainees, practices are suffering from a dearth of partnerships – one in 10 partnership vacancies are know to go unfilled for more than a year while around 25% are vacant for six months.

Some practices have been forced to offer £20,000 ‘golden hellos’ to attract partners.

 

NHS CHIEF BRANDS GP RECRUITMENT STRATEGY ‘CRAZY’

From the FMS Global News Desk of Jeanne Hambleton                 PULSE TODAY By Sofia Lind 1 September 2014

 

The chief executive of NHS England has said that the GP recruitment strategy over the past ten years has been ‘crazy’, with four times as many graduates entering specialist training than general practice.

Responding to questioning by the Public Accounts Committee (PAC) today (Monday), Mr Stevens said ‘there clearly are substantial pressures’ on the GP workforce which mean that NHS England has to ‘make coming into GP training more attractive, including attractive relative to hospital medicine’.

Mr Stevens blamed recruitment trends over the past 10 years for the situation NHS England now finds itself after being put under pressure by PAC chair Margaret Hodge MP on whether the NHS is recruiting enough GPs within the right timescale to ensure there are sufficient GPs.

The PAC was questioning NHS England’s management team in light of a National Audit Office (NAO) report published in July that showed that 60% of out-of-hours providers are unable to fill gaps in GP rotas.

Mr Stevens said: ‘GP numbers are increasing but there clearly are substantial pressures and one of the things that we have got to do is make coming into GP training more attractive, including attractive relative to hospital medicine because one of the great unplanned consequences of the last 10 years is that whereas GP numbers are up by between a fifth and a quarter, the number of hospital consultants is up by 76% in whole-time equivalent terms.’

‘If someone had said 10 years ago that the NHS’s game plan for the next 10 years is to have between three and four times more hospital consultants added to the roster than GPs, people would have said “that’s crazy”, but that is what has happened.’

Asked by the committee why he thought that was, Mr Stevens said: ‘My personal point of view is that one of the things that has driven that is the way that the European Working Time Directive has been implemented. I think it has had the effect of sucking in doctors into hospitals to create legal rotas and to some extent training has been the tail that has wagged the dog.’

Mr Stevens also admitted that NHS England has no game plan for how what sort of increase in GP numbers that the health service will need by the end of this decade, but blamed the Government’s lack of direction on how much NHS funding will be available to staff the NHS in general.

He said: ‘We do not have a single model for GP numbers and the simple reason is that we have no idea what resource is going to be available to the NHS come 2020. As and when Parliament sets us a budget through the end of the decade we will then be able to work out what our staffing can be based on the resources.’

It comes as health education managers in the south west of England have been forced to to arrange a ‘crisis summit’ to tackle acute problems in the GP workforce and as Health Education England (HEE) announced in July that it was running an unprecedented third recruitment round for GP trainees after Pulse revealed that as many as 40% of training places were going unfilled in some parts of the country.

 

GP PARTNERSHIPS WILL BE GONE IN TEN YEARS, SAYS NHS ENGLAND OFFICIAL

From the FMS Global News Desk of Jeanne Hambleton Sept.10 2014                                      Pulse Today by Joe Davis

GPs’ independent contractor status will be ‘probably be gone’ within ten years, NHS England’s deputy medical director Dr Mike Bewick has claimed.

Speaking at the Westminster Health Forum conference in London yesterday, Dr Bewick said that the current organisational structure of primary care is no longer ‘sustainable’ or ‘desirable’, partly due to the ongoing GP recruitment crisis.

He added that he expects new provider organisations to develop within a decade because the current model will not serve the patients’ needs, adding that the difficulties of recruiting GP partnerships will consequently mean that ‘we will have to think of something different’.

Dr Bewick told delegates: ‘The current organisational structure of primary care is no longer sustainable or, increasingly, desirable. I am going to say just two things that I think are going to be true: one is that in 10 years’ time the term independent contractor will be anachronistic and probably it will be gone. And the second is that we will not talk about primary care, we will talk about out-of-hospital provision and out-of-hospital providers.’

He also said that he expects each new provider model to accommodate around 300,000 patients – similiar to CCGs

‘In primary care at the moment, more than 50% of doctors are salaried,’ he said. ‘There will be a force majeure that will move away from a partnership type organisation because it will not serve them and equally when you cannot recruit to partnerships, it will mean we will have to think of something different.’

However, despite proposing a move to larger primary care organisations, Dr Bewick said that this would not be at the expense of local healthcare services.

‘I do not think we should confuse that with not delivering healthcare by people you know in your locality. Localism is in my blood.  

‘We should be forming organisational mergers with either community trusts or secondary care, or with other providers from other sectors. Providing they have the values of the NHS at their heart, I am not too worried about who delivers but more how it is delivered and the outcomes for patients.’

Professor Clare Gerada last year said that all GPs should become salaried in her last speech as chair of the RCGP, comments that her successor Dr Maureen Baker rebuked shortly after taking office,

 Where will it end? Back tomorrow I hope, if my computer is in the mood….. Jeanne

 

 

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