Tuesday, November 21, 2017

GPC report 16 November 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16 November 2017

The GPC met on Thursday.  This was my first meeting for some time, having missed the last one for family reasons. GPC meets less frequently now, a fact I am still not convinced is sensible.  This time was a GPC England meeting, held at BMA House in London.

Much of the subject matter is confidential but hopefully only until Monday when the official GPC News comes out.  My plan (and you will be able to judge how effective it has been) is to send this report out with the official news. That way you'll get my impressions and the official bits side by side.

Negotiations for 2018/19: 
Negotiations are progressing but are currently strictly confidential.  As previously, this annual round of agreements is not going to solve the problems we face.  We were given much detail to allow us to decide whether to approve of the executive team's direction of travel. Broadly, we do.  More details when I am allowed to.

Update from the exec team and policy leads:
In a new format, we were provided with a written update from the executive team and policy leads.    This is confidential until Monday but is going to form the basis of the official GPC News.  There has been much work (as always) and I hope the new format will be more informative.  Suffice to say here that Julius and I are on different policy groups which we think will be complimentary to each other for Surrey and Sussex.  The subcommittees no longer meet, much of the work is undertaken electronically.  Whether this will continue I don't know but from a workflow point of view it seems to be working. That said, many of us feel disconnected from the work, with the lack of face to face meetings making discussion perhaps less productive. Nevertheless, I understand there will soon be policy group specific pages on the BMA website, if you feel the need to see how the work is divvied up.
Letter to Simon Stevens: Richard Vautrey has written to Mr Stevens to highlight the continuing farce that is Primary Care Support provided (using the word loosely) by Capita. Did I spell that correctly? Yes, good.  There are multiple issues which I suspect will be included in GPC news. Mr Stevens recent speech was both unprecedented and welcome in its criticism of NHS funding.
Practice closures: There has been much work by the BMA Comms team resulting in much media coverage.
Indemnity: there has been a high level meeting with various stakeholders to try and thrash out requirements going forward. It is recognised by DH that something must be done and soon. More meetings are planned.

As I think the policy area reports will be in GPC news, I won't cover them here but may comment depending on what ends up being published. Questions from you are as ever welcomed.

Saving General Practice
Following the publication at LMC Conference of the document of the above name, we discussed next steps. If you haven't seen it, it is available on the BMA website here. Comments welcome.

Scotland contract update
Although an England meeting, we were treated to a 45 minute update on the Scotland contract negotiations, details of which are on the BMA website. It was interesting but given the differences between the NHS in the two countries I am not sure some or indeed much of it could be applied in England. It seemed to me to be a step closer to a salaried service, albeit that it was emphasised that the independent contractor model was being promoted.

Accountable care models
We received and briefly discussed the BMA response to a consultation about proposed changes to the regulations to allow their development. The consultation was actually quite limited in scope but taking into account the views of various branch of practice committees including GPC the response was focussed and constructively critical. In particular the point was made that service integration does not actually require a new contractual model.  Again. The BMA response can be found at here.

LMC England Conference
As usual, a paper had been prepared for GPC outlining the motions passed and what effect these have on workflows and policy. Of course, most of us where there anyway as voting members of LMCs.... The BMA has published news from Conference here. There is also a webcast if you missed Conference and want to watch some or all of it. Yes, I know, but I felt I should tell you it's there. You know, in case you have a spare few hours.

NHS England review of urgent care
A large document entitled "Integrated Urgent Care Service Specification" was provided to us. It is only 148 pages if you fancy going to look for it. As ever with NHS England work of this nature, it makes enormous assumptions about General practice and it won't work without huge investment of resources, which ain't going to happen. Plus ├ža change.

The next GPC meeting is in January, a GPCUK meeting being held in Edinburgh.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 

Friday, June 16, 2017

GPC report 15 June 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 June 2017

The GPC met today.  This was a GPC England meeting, the last of the current Bma year, with the Annual Representatives meeting later this month. Our current chair of GPC, Chaand Nagpaul, will be moving to take up the position of BMA Chair of Council.  This means that both GPCE and GPCUK will need new chair electing in July at the next GPCUK meeting.  At the moment I am unable to tell you who the candidates actually are as they can't technically throw their hats into the ring until nearer the time.  I have a couple of ideas who might though. I suspect we will end up with at least one new member of the executive team.

Much of the subject matter today is confidential but as usual I will tell you what I can. For a change I am going to try writing my report in real time, during the meeting.  Apologies in advance for any spelling or grammatical errors.

Chairman's report
Chaand gave a summary of events during his tenure, in particular the changes from last year and in particular the success of not allowing changes to our core hours. He also outlined the difficulties we are facing.  Quality First has been a success, with an emphasis on supporting Gps in resisting inappropriate demands on their time.

Indemnity
With recent changes in the law about the discount rate applied to compensation awards, it is likely that there will be a significant change in MDO subscription costs for GPs. Discussions regarding solutions are ongoing with the MDOs and representatives of the Department of Health who are well aware of the potentially destabilising and even catastrophic effects this issue may have on general practice in England.

UEMO
There was a recent conference held at BMA House which was a great success.  Details at the website.

Resolutions from the 2017 Conference of LMCs
Colleagues will have seen the Conference News published by the BMA, some may even have read it if unable to sleep. There was lengthy discussion about several of the resolutions with breakout groups to look at the best way to implement them.  It is conceivable that the views may change depending on the election on a new chairperson for GPC.   Effort is being put into having a proactive narrative, telling others what we think is needed rather than simply delineating the problems.

The official GPC news can be found soon at the usual bit of the BMA website.  This often includes information that is said to be confidential in the meetings but nevertheless works its way into the documents!

The next GPC meeting is in July, a GPCUK meeting.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

Saturday, March 25, 2017

GPC report 16 March 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16 March 2017

The GPC met last week.  This was a GPCUK meeting, with representatives from all four nations being present, with discussions regarding pan-UK issues.

Contract 2017/18
I know by now that you will all have seen details of the agreed contract for next year. In the context of an annual review, it is a good deal, with CQC fee reimbursement, changes to sickness expense reimbursement and a significant reduction in bureaucracy major improvements. That said, it is in no way a rescue package nor will it do anything to sustain GP in the longer term.  But then that's what the GPFV is for, innit?  That'll be a panacea, opening vistas of delight and joy.  The LMC is working with CCGs to try to ensure that money is spent where the centre intends it to be spent.

Update on GPFV
On which note, we heard in the England report that the funding is starting to make its way to the front line in places.  As usual with these national ventures, this is highly variable and local hoops to jump through are being deployed by some areas.  In East and West Sussex (and the rest of the Lmc federation) we continue to engage as a constructively critical stakeholder with the commissioning bodies.

Intermediaries legislation
We received an update on the changes with the IR35 issues.  A briefing note from Julius has already been sent out from the LMC office for practices and GPC guidance for practices is being developed. Sessional colleagues can access guidance specific to Locums at the following two links:
www.bma.org.uk/advice/employment/tax/ir35-advice-for-locums
www.bma.org.uk/advice/employment/gp-practices/gps-and-staff/a-guide-to-employment-status


GPC Reform
We had a an update of progress in the reform of GPC to try and modernise the way it works.  This has been an ongoing project and I have no doubt that there will be an update at the forthcoming LMC conference in May.  While this work is important, I feel frustrated that so much time is devoted to it within the committee meetings.  I doubt whether many of you are overly interested in its details.  I have fed back that in my humble view it would be better as a receive item.  This view has had a sympathetic reaction from numerous colleagues on GPC but by no means all.

Firearms guidance update
We received a brief oral update as significant progress has been made. Guidance can be found on the Bma website at the link below. It is worth noting that the GMC may decide to make further comments in the near future...
Firearms updated guidance (https://www.bma.org.uk/advice/employment/ethics/ethics-a-
toz/firearms)

Qof update
Discussion has started about the future of QOF.  This is currently confidential but expect changes going forward.


National committee reports
We received oral reports from the Chairs of the national committee in the UK.  The variability is interesting, as is the way that conversations with NHS senior management seem to gradually incorporate ideas from elsewhere in the UK. It's almost as if we had one national health service.  Of note in the English report for my constituents was the fact that the Capita situation may be showing the first green shoots of improvement.  Let's hope they've got decent compost.

The official GPC news can be found at the usual bit of the BMA website.

The next GPC meeting is in June though there is the annual conference for LMCs  in May which I will be attending as a member of East Sussex LMC.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

Saturday, January 21, 2017

GPC Report 19 January 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
19 January 2017

The GPC met this week.  As I had to miss the November meeting after one of my partners was unwell (now fully recovered I am delighted to report) this is my first report for some months (please, not too much cheering at the back).  You may recall that there are now fewer meetings generally.  This meeting was of GPC England, so slightly smaller.

Contract negotiations 2017/18
I can report that negotiations have moved on after an uncharacteristically late start. I can't report any of the details or discussion however.  I should have more info in a few weeks that I can share and discuss with you.

Update on GPFV
We heard from Lena Levy, the Policy Lead within the BMA for Health Policy, and several GPC members of work around the GPFV but, in essence, it continues to be worked on.  Nobody thinks it will save general practice but it may help us keep going while we try and persuade those holding the purse strings of the necessity of more support.

STPs
We received an update on STPs, all 44 have now been published but are often difficult to find. With that in mind the BMA have a dedicated page on the website at www.bma.org.uk/stp where you can find much information. It would be fair to say that the plans are at best a mixed bag.  I couldn't possibly comment on whether anybody including the authors think the savings anticipated in many of the plans are in any way grounded in the reality that you and I inhabit rather than an alternative and possibly drug addled universe.

MCPs
We received an oral update on how things progress. In some areas of the country, there have been exciting and possibly helpful developments.  In others, the more usual morass of confusion and lack of engagement continues unabated.  In many areas there seems to be a move towards an accountable care model.  In some of those, the aim would appear to be a salaried GP service. Quite how that fits with us maintaining our independence and role as patient advocate the deity of your choice only knows. One only has to look at what has happened to our Public Health Colleagues for an idea, I suspect. Make sure you are aware of local plans and further more are involved and willing to hold the organisers to account if you feel unable to support their work.

GPC survey update
We received a brief oral update on the results of the GPC survey which have been gradually released with much media coverage.

CQC update
There have been a variety of issues around CQC, including a consultation on how they monitor and inspect services, a change in "Intelligent monitoring" to "GP Insight" (I would note that many of us think we have considerable insight into CQC and how it works already but that is not, apparently, the point).  The CQC published its "State of Care" report (here) which showed that 87% of practices were rated good or excellent, 10% require improvement (usually around processes rather than patient care) and only 3% as inadequate.  Apparently 800,000 patients are registered with services rated inadequate for safety.  The CQC definition of safety is not always as intuitive as you might expect and I would recommend looking at "Nigel's surgery" on their website.

The official GPC news can be found at the usual bit of the BMA website.  This month it includes details of the robust response to the Prime Minister's ill-informed pronouncement on seven day opening.  Apparently this came as a surprise to the Department of Health, NHS England and even Jeremy Hunt. It also includes a section on the National Audit Office report (mis)quoted by Mrs May which makes both interesting and sobering reading.

The next GPC meeting is in March though there is a conference for English LMCs and GPC England members on 23 February entitled "Working together to sustain general practice - England" which several of the LMC's Medical Directors and I will be attending. I will report back after that.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

Saturday, September 24, 2016

GPC report 15 September 2016

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 September 2016

The GPC met on 15 September 2016.  We started with a meeting of the GPDF, where various decisions were made and newer members of GPC were utterly confused and nonplussed.

The meeting proper was the first GPC UK meeting and unfortunately I can report very little of it for reasons of confidentiality. Which is frustrating, as ever.  What I can say is that the devolved nations are facing similar problems to us in England and solutions are proving problematic.

The new Executive team for GPC England has been announced with two new members, Dr Mark Sandford-Wood (Devon) and Dr Gavin Ralston from Birmingham.

The failure of pretty much everything and anything Capita are doing was discussed and GPC continues to take both them and NHS England to task about notes transport and everything else. The degree of incompetence in commissioning and delivery is staggering.

In the afternoon we had breakout groups to discuss a variety of topics around how general practice might be supported better and differently.

And that is all I can say I'm afraid.

The official GPC news can be found at the usual bit of the BMA website.

The next GPC meeting is in November.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

Wednesday, August 03, 2016

GPC Report 21 July 2016

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
21 July 2016

The GPC met on 21 July 2016.  Apologies for the delay in getting this out to you, I have been eating and drinking too much with friends in France.  There will be no such excuses for the next report. 

Chaand Nagpaul was re-elected, unopposed, as the Chair of GPC UK and the new post of GPC England.  there have been changes which I have described in previous reports.  For a reminder, check the BMA GPC pages which can be found here.

News about a list cleansing project (again) appeared in the medical press just before the meeting.  the process was apparently to be led by Capita, which I am sure will fill colleagues with a sense of confidence, although confidence may not be the appropriate word.  However there had been no discussion about the process with us and NHS England have apologised.  Any process will need to be discussed with us and we will not accept any proposals which will damage General Practice.

Subsequent to the report about this issue, a motion was passed by GPC, a relatively unusual event.  The motion was as follows, and passed unanimously:

That GPC UK notes how the NHS England commissioned service for Primary Care support in England with Capita has seriously compromised patient safety and caused significant disruption to GP surgeries already under unprecedented workload pressures, and therefore has no confidence with these arrangements.

Furthermore GPC UK insists that the plans for removing patients from practice lists, which may be illegal and discriminatory, should be abandoned and NHS England must commit to discussions with GPC England before any further list management plans are put in place. 

Furthermore, on the day of GPC a significant event came to light regarding the so-called transformation of primary care support services.  Colleagues may have seen an article in Pulse about this issue.  In essence, in some areas where SBS had been providing support (I use the term loosely) it was discovered that a backlog of clinical correspondence and results stretching back over several years remained in storage areas and had not been processed.  The correspondence includes temporary resident forms, duplicate documents or some results and communications about treatment steps.  NHS England have undertaken a clinical review to assess any high risk correspondence.  GPC is discussing a remuneration and support package for practices which are impacted by this event.

The Carr-Hill formula review, due to be implemented in April 2017 has, utterly unsurprisingly, been delayed until 2018.  I will believe it when I see it.

There was further discussion about how to respond to the decisions reached at LMC Conference recently.  These discussions are currently confidential but as ever I will supply more information when I can.

The issue of an indemnity support scheme was discussed.  Conversations with NHS England continue but the current iteration can be found here.  It is a start but not ideal.

The official GPC news can be found at the usual bit of the BMA website.

The next GPC meeting is in September, and every two months thereafter.  So a silver-lining, you will be getting fewer of these from me!

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

Wednesday, June 29, 2016

GPC Report 16 June 2016

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16 June 2016

The GPC met on 16 June 2016. Apologies for the delay in getting this out to you.
The first meeting after the annual LMC Conference, there was much to discuss. However, as ever, much of the discussion is confidential. Additionally, the afternoon was taken up in part by Subcommittee meetings, though on this occasion the subcommittees were essentially continuing more focussed discussions as a result of the events and debates which had occurred in GPC.
Workload management was discussed and it evident that there is significant common ground between GPC and NHSE, at least in terms of context and a recognition of the crisis that is occurring in General practice. There was considerable discussion around how GPs can or could manage their workload with patient safety in mind, following on from discussions at LMC Conference. This limiting could take several forms and more info will be forthcoming in due course. The Primary Care Hub was discussed in this context too. These are suggested to provide additional capacity when general practice runs out of it. Discussions around he funding of them were varied. Whatever happens, the direction of travel is for these to be in our futures in some form or other. It is important that we not only influence but control those developments.
Colleagues may recall the Quality First templates and information released by GPC in January 2015 (yes, over a year ago). A new web portal providing easy access to the information, which is intended to be updated frequently has been published on the BMA website. A first look impressed me with its ease of navigation and usefulness, not something I have previously noted in iterations of the Bma website.
The rest of the meeting was confidential but covered areas such as the actions necessary following the LMC Conference, the GPFV and the continuing development of the MCP Voluntary contract, which is currently subject to purdah, so expect news shortly after the Referendum.
The next meeting is the first in a new GPC year in July, after the BMA's ARM in Belfast next week. There will be changes to how things work, with GPC UK becoming an entity which meets 2-3 times a year and GPC England meeting 4-5 times. This is part of the changes suggested in the Meldrum review which will hopefully strengthen the LMC/GPC relationship to the benefit of both and our constituents.
The official GPC news can be found at the usual bit of the BMA website.
I hope you have found this report helpful. Please feedback so that I can ensure my reports are useful.
Dr Russell Brown