Practices may be struggling to pay for locums

GP leaders have called for additional roles funding to include locum doctors as it has emerged that some are struggling to get work. Official NHS figures show a 35% reduction in the number of ad hoc locums working in general practice in the last year.

Dr Mark Steggles, Chair of the sessional GP Committee at the BMA, told the Guardian: “I’ve heard from locums who have been working for ten years and their work has gone overnight. Many surgeries simply cannot afford to hire the GPs they need.”

The Royal College of GPs Chair, Professor Kamila Hawthorne, said: “It’s extremely frustrating to hear accounts that some GPs are struggling to find vacancies. While many practices are desperate for more GPs to ensure that they can give patients access to safe and timely care, the rules around the Additional Roles Reimbursement Scheme are limited. While members of the wider practice team are highly valued, these roles aren’t substitutes for GPs and mustn’t be used to plug gaps in the workforce. The College has been calling on the Government to allow practices to use ARRS funding to recruit more GPs and to increase the overall funding for general practice so we can recruit all the staff we need to meet patients’ growing levels of demand.”

English premises scheme updated

GP leaders have welcomed new guidance on premises payments, allowing grants to cover the full cost of improvement. The long-delayed changes to premises rules were first agreed in 2019 and there is now, finally, guidance from the Department of Health and Social Care on the new rules. The BMA said it’s still awaiting further details, but the guidance sets out new powers for commissioners to improve support for contractors on the management of premises together with a lifting of the threshold for improvement grants – which had stood at 66%.

Dr Gaurav Gupta, premises lead at the BMA’s GP Committee for England, said: “This update has been in the pipeline for many years, so this is good progress for our members who have been patiently waiting. But we still have a very long way to go, with no additional funds going into integrated care board budget lines.”

New practice support programme announced

A new programme of support will be delivered by the Royal College of GPs through a contract with NHS England. Practices will get support for periods of up to six months.

The college is offering “tailored” analysis of practice demand and capacity. It plans to deploy “experienced and skilled” facilitators to practices and set up group-based learning sessions to ensure experience sharing across practices. It is basing the programme on an established primary care development programme it has been running. Sessions begin in July.

Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: “GPs and their teams are working under intense pressures to deliver care for their patients, so the College is looking forward to working with practices on the ground to deliver much-needed support.”

Welsh debate over practice closures

GP leaders in Wales have called on their government to improve its understanding of why practice numbers are reducing. The issue was being debated yesterday by the Welsh Senedd. A Conservative motion said it “regrets” that the practices in the country had reduced from 473 in 2012 to 374, and called for urgent action to prevent a 100th closure.

The Royal College of GPs’ Chair in Wales, Dr Rowena Christmas, said: “…smaller practices which tend to be more financially vulnerable have been lost. Where the affected patients have been moved to other practices this has not typically been a matter of maximising resources but rather necessity. I would encourage evaluation of the impact of this on patients. I am sceptical that this scenario has been of benefit to patients and fear that practices with larger patient lists are struggling with greater demand but little uplift in resource.”

She added: “There is a very practical obstacle to the idea of a larger practice by design model; there simply is not the primary care estate to properly accommodate such services in most settings.”

Scottish practices precarious after loan scheme paused

The BMA has warned that dozens of practices in Scotland are facing a “precarious” future following the pausing of a practice loan scheme. A BMA survey found six practices saying they would probably hand back their contracts, while 30 reported precarious circumstances. It followed the pausing of the GP Sustainability Loan Scheme.

The scheme was introduced in 2018 as part of the GP contract and allowed long-term, interest-free loans of up to 20% of the value of a practice. The Scottish government has put a hold on new applications, but said it hopes to resume the scheme. Under the scheme, practices would repay the loan upon sale of the premises and the local health board would have first option to purchase the building. The BMA said the intention was to ease the financial burden of owning a practice.

Dr Andrew Cowie, Deputy Chair of BMA Scotland’s GP Committee, said: “We have been hearing many concerns from GPs over the pausing of the sustainability loan scheme – and this alarming survey reveals the huge impact even a short delay may have on practices that are already under pressure with inadequate workforce and resource to meet the needs of the communities they serve.”

Waiting lists stay high in spite of improvements

The NHS waiting list has stayed at its record high of 7.5 million, although NHS England has claimed improvements in urgent care.

NHS England said hospitals had faced a record April for emergency department attendances and admissions, but there were improvements to ambulance response times. The organisation says it’s now meeting its target to achieve cancer diagnosis decisions within 28 days of referral for 75% of patients.

Rory Deighton, Director of the NHS Confederation’s Acute Network, said: “There is no question that services are facing incredibly high demand and we know far too many people are still waiting too long for their care, including to start cancer treatment. This stems from a decade of underinvestment in capital, workforce and social care.”