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by in NHS, Political

NHS - New deal or no deal?Much has been made in the media of Health Secretary Jeremy Hunt’s recent speech where he promised GPs a ‘new deal’ to alleviate pressure on over-stretched services, through increased investment, reduction in bureaucracy, and the drafting in of more healthcare professionals to the areas most in need.

The speech was a typically politicised mix of previously made statements and new promises. For example, as previously announced, around 10,000 extra healthcare workers, including 5,000 more GPs, have been promised for primary and community care, but recruitment will be focused on the most under-doctored areas where the problems are particularly acute.

Elsewhere, think-tank The Health Foundation is to assess and update the indicators currently used to measure GP performance, while NHS England/NHS Clinical Commissioners have been tasked with developing a £10 million programme of support for struggling practices, to address problems more quickly. NHS England will also look at how bureaucratic burdens on general practice can be reduced in order to release more clinical time for patients.

What’s the impact on GP practices?

While there was plenty of rhetoric, what impact will the speech have on practices and practice managers?

In the short-term, the honest answer is that not a lot will change, as policy makers take time to sort out policies – and we certainly won’t see a glut of newly qualified GPs entering the job market any time soon. At a local level we could see the roll out of pilot schemes (such as seven-day opening trials) but most changes will be mid- to long-term and the majority of policy changes don’t have a timescale attached. Indeed, Maureen Baker, chair of the Royal College of General Practitioners, said: “What we need now is a clear and costed plan for turning this into a reality – and a timescale for how quickly this can be delivered”.

Thoughts on the changes

While we can’t be sure what changes will be implemented and when, Practice Index has been through the full speech and extracted the following key points that will have an impact on practices:

Seven-day access: Hunt confirmed the previously announced drive towards seven-day access, which is all about “making sure precious hospital capacity is kept clear for those who really need it”. How this will work is still up for discussion, especially as local pilot schemes prove that public demand is low and most practices would rather see money being spent on relieving pressure on Monday to Friday services.

Retiring GPs: First announced in the NHS England ten-point plan last year, ‘new flexibilities’ will be rolled out for GPs reaching retirement age. These are to be worked out with the BMA and the RCGP and Practice Index has heard that the roll-out is fairly close, so watch out for news shortly.

Physician associates: Over 1,000 will be available to work in general practice by 2020, according to a new deal announcement. NHS Leicester City CCG is spending £600,000 on bringing over ten US-trained physician associates to work in local GP practices. If this is shown to be successful then watch out for similar schemes at your local CCG.

Workloads: Hunt said that an integral part of the New Deal was NHS England producing stats about clinical staffing levels per patient. This will be used to work out where recruitment needs to be focused, both in terms of staff shortages within practices and in geographical terms around the country. This is expected to take time to collate and then the powers-that-be need to decide what they’re going to do with it.

Reducing bureaucracy: NHS England is to develop tools to help practices reduce the reporting burden and manage the mountain of bureaucracy. In the New Deal announcement it was said that changes should be in place by the autumn.

Community pharmacists: A total of £7.5m of funding is to be used to train community pharmacists and give them appropriate tools to ease GP workloads. Once again, this is unlikely to happen overnight but funding is likely to be made available later this year.

Funding where it’s needed: NHS England is to work with commissioners to develop a £10m programme of support for struggling practices to help keep them in business. This will be rolled out as soon as the data has been gathered and analysed.

More public data: It was announced that the Health Foundation is to work with NHS England on ways of publishing practices’ clinical outcomes relating to vulnerable patients. The first data is expected to be published in Spring 2016 although data collection will start soon.

Reaction from the front line

With very little detail and minimal timescales attached to last week’s speech, it’s understandable that reaction to the New Deal has been negative. One practice manager described it as being like “shifting the deckchairs on a sinking ship”. Others say that it does nothing to encourage GPs to stay in the profession and exacerbates the GP shortage problem.

A group called the Campaign for GP Survival launched a petition, signed by nearly 3,000 people so far, saying that the plans would ‘erode primary care and put patient safety at risk’. It called a £10m fund announced by Mr Hunt to support struggling practices ‘a sticking plaster’.

“Nothing in this so-called ‘New Deal’ will help us with our real and present struggle to manage Monday to Friday services given current levels of demand. Extending hours will actually cause the loss of continuity of care as services are spread more thinly,” it said.

The petitioners propose that the government and NHS England should increase primary care investment to 11% of the NHS budget, invest in existing GP out-of-hours services, tackle indemnity costs, scrap unnecessary regulation and refrain from negative press to help improve morale.

What are your views on the New Deal? What would you do to improve the current situation? We would love to hear your thoughts which you can share below or in the Practice Index Forum.

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