The big news this week was the long-awaited announcement by the NHS of its big-money rescue plan for general practice. In what has been called the “most significant announcement for our profession since the 1960s”, spending on general practice is to increase by £2.4 billion a year by 2021 – a 14% increase in real terms. The extra money means more than 10% of the overall NHS budget will go on GP care – up from just over 8% currently.

So what will that money be spent on and will the plan address the real issues practices are facing? The plan contains specific, practical and funded steps to strengthen workforce, drive efficiencies in workload, modernise infrastructure and technology, and redesign the way modern primary care is offered to patients. Some of the key points are:

Investment

In addition to the headline figures, in the short-term, GP funding will increase by 4.4% in 2016/17 – equivalent to £322m. This could be topped up by local investment by CCGs under sustainability and transformation plans, which are required to ‘secure and support general practice’.

What’s more, NHS England has pledged an extra £500m to CCGs to commission routine seven-day GP access. However, the good news is that rather than the government’s manifesto pledge of routine seven-day access for all, the Forward View said that this would be based on ‘locally determined demand’.

From April 2016, CCGs, local authorities and NHS England will be able to pool budgets to jointly commission expanded services, using the expanded Better Care Fund. This includes:

• additional nurses in GP settings to provide a coordination role for patients with long term conditions;
• GPs providing services in care and nursing home settings;
• providing a mental health professional in a GP setting; and
• hosting a social worker in a GP surgery.

Rising indemnity costs will be tackled to ensure ‘GPs should be no more exposed to the rising costs of indemnity than hospital doctors’. Various consultations are planned – look out for them coming your way soon.

Workforce

The plan details action to double the growth rate in GPs, through new incentives for training, recruitment, retention and return to practice. This five year programme includes:

• Increase in GP training recruitment to 3,250 a year to support overall net growth of 5,000 extra doctors by 2020 (compared with 2014).
• Major recruitment campaign in England to attract doctors to become GPs, supported by 35 national ambassadors and advocates promoting the GP role.
• Major new international recruitment campaign to attract up to an extra 500 appropriately trained and qualified doctors from overseas.
• Targeted £20,000 bursaries in the areas that have found it hardest to recruit into GP training.

There are also plans to attract a minimum of 5,000 other staff working in general practice by 2020/21. This five year programme includes:

• Investment in an extra 3,000 mental health therapists to work in primary care by 2020, which is an average of a full time therapist for every 2–3 typical-sized GP practices.
• Current investment of £31 million to pilot 470 clinical pharmacists in over 700 practices to be supplemented by a new central investment of £112 million to extend the programme by a pharmacist per 30,000 population for all practices not in the initial pilot – leading to a further 1,500 pharmacists in general practice by 2020.
• Introduction of a new Pharmacy Integration Fund.
• A general practice nurse development strategy, with an extra minimum £15 million national investment including improving training capacity in general practice, increases in the number of pre-registration nurse placements, measures to improve retention of the existing nursing workforce and support for return-to-work schemes for practice nurses.
• National investment of £45 million benefitting every practice to support the training of current reception and clerical staff to play a greater role in navigation of patients and handling clinical paperwork, to free up GP time.
• Investment by HEE in the training of 1,000 physician associates to support general practice.
• Introduction of pilots of new medical assistant roles that help support doctors, as recommended by the RCGP.
• £6 million investment in practice manager development, alongside access for practice managers to the new national development programme.
• £3.5 million investment in multi-disciplinary training hubs in every part of England to support the development of the wider workforce within general practice.

Notable points

Other notable points outlined in the strategy include:

• a dedicated pot for extra support, including help for GPs suffering stress and burnout
• a relaxation of rules, making it easier to renovate premises or build new ones
• streamlined inspections for the best-performing practices, meaning re-inspections need take place only every five years
• a public campaign to encourage junior doctors to become GPs
• the recruitment of 500 doctors from abroad to boost numbers

Initial reaction

The majority of people we’ve spoken to seem happy that, at last, investment is being made in primary care – and in many of the areas where funding is most needed.

However, some people are still wary of the announcement. British Medical Association GP leader Dr Chaand Nagpaul said the strategy was a “vital step”, but added it was essential “words are translated into action”. A practice manager added that we need to be careful that it’s not another example of the NHS “talking the talk and failing to walk the walk”.

Sceptics also say that, if you analyse the figures, the additional funding destined for practices is actually small when the chunk destined for social care is taken away.

It will undoubtedly take time to digest the Forward View and its full contents, and we’ll have to wait and see how much of a difference it really makes, but at least there’s a plan in place that the NHS has committed itself to.

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