Saturday, September 26, 2015

GPC report from 17 September 2015

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
17th September 2015

The GPC held its latest meeting on17th of September.  

The meeting started with the AGM of the GPDF with election of Directors.  Stuart Kay was elected as the Chairman of the Board.  Colleagues may be aware of Stuart’s son,  Adam, who is part of Amateur Transplants and well worth seeing if you get the chance.   Alan McDevitt and Douglas Moerderle-Lamb were elected as Directors of GPDF.

The “official” GPC news can be found at It is worth a read for LMC members.  Other colleagues reading this may find some it less relevant to them personally in places.  Your mileage may vary.  (I have come across other VW-based jokes this week but there are too many to recall, it would be too exhausting.)

Pensions were discussed, especially the iniquitous position of locum GPs in the scheme, who are viewed as casual workers and so don't qualify for death in service.  Work is ongoing to try and change this.

Supporting practices:  NHS England apparently have £10 million to transport general practice. Despite numerous and detailed representations they have realised recently that they are going to have to spend at least a proportion of that to try and quantify the problem they are facing. In other words, although they have not said as much, they have realised that £10 million is an inadequate sum. Personally, if they stuck a few extra zeros on the end I think we might be closer to solving some of the problems.

Seniority: a “Focus on” document was recently published which explains the changes which are happening. Essentially seniority will go down and global sum will go up. There is a target to reduce seniority payments by 15% per annum over the next seven years. However as this year is starting in October, the reduction will be 11% overall this year. Unfortunately, as we are starting midyear, this equates to a 23% reduction in seniority for the rest of this year. In future years the reductions will start from April and will be 15% of the budget.

Updates on payments to practices: things seem to be working somewhat better in most places now. Nevertheless there’s been some interesting figures released by HSCI which show that the proportion of the NHS budget spent on general practice reduced from 10.4% in 2010/11 to 7.4% last year. Additionally there is a significant differential funding per patient per year between GMS, PMS and APMS practices of £137, £144 and £190 respectively. Of course we all knew this already and the rest of the NHS is only just catching up with this several years down the line.

Recruiting and retaining GPs: the recently announced contract in position on junior doctors is likely to have a major impact on general practice recruitment. Taken in context with the current recruitment difficulties, the word “catastrophic” wandered across my consciousness during the meeting. Though I have always been a fan of the concept of cockup rather than conspiracy, I am beginning to wonder

Physicians associates: despite the fact that nobody is really clear what role these health professionals might have a general practice, as so far they’ve been used almost exclusively in hospital practice even in the USA, moves are afoot to move this forward. Given that they will have no obvious regulatory body and will not be able to prescribe I am concerned about workload implications for GPs as well as the obvious indemnity issues.

 All in all I am rather depressed.

The afternoon was taken up with subcommittee meetings where, as a member of the commissioning and service development subcommittee, I was engaged in interesting discussions about future models of care. The Vanguard sites are doing some interesting work. Change is coming and I am uncertain how this will affect practices. I am also uncertain how I may be able to help protect practices and locums. The roles of LMC's and the GPC will I suspect change as the structures within the NHS do.

The next GPC meeting is scheduled for October. 

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

Dr Russell Brown

Tuesday, July 28, 2015

GPC report 16 July

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16th July 2015

The GPC held its latest meeting on16th of July.  I delayed sending this report so that I can include a “Focus on…” document regarding SAR requests from insurance companies, which have been driving my secretary mad. In essence the ICO wrote to the insurance industry and told them that utilising a Subject Access Request for the purposes of the insurance business was an inappropriate use of the Data Protection Act. This should save quite a lot of administrative time as we won’t have to copy so many sets of notes. Please note this does not apply to most of the requests we receive from solicitors, but only most of them.  (For blog readers, the document is at Focus on Subject Access Requests for insurance ... - BMA)

The meeting began with a two-hour session on the role and structure of the general practitioners defence fund. I would like to report that this session was engaging and useful. Unfortunately the way matters were presented seemed to suggest that the changes being suggested had already been decided upon. In the end however it became clear that further work is needed before any decisions are taken.

The executive team report confirmed that as usual,  the NHS employers are still waiting for a mandate for negotiation.  While we are waiting for this to happen we need to consider carefully and imaginatively anything which can keep us afloat. Our negotiating team have already asked for stability, reduced administration and more resources.
  • GPC is looking to set up some kind of emergency practice support fund to try and proactively avoid a crisis in a locality which may then result in a domino effect.
  • the formula review group looking at the Carr-hill formula includes representatives from GPC  but is in the very early stages of work. There is also a parallel work stream going on to look at atypical practices.  This may be ready for 2017-18, but will be subject to review and agreement. Practices should not depend on the review from making any long-term decisions on funding.
  • Workload and  efficiencies: monitoring and quantifying GP workload is needed to help in negotiations and for our DDRB 
  • Gp networks: work continues to facilitate the development of GP networks including the development of the database of organisations
  • in November there may be regional meetings as pilots of GPC and LMC’s meeting together. It will be interesting to see how this works
  • premises:  GPC is in the middle of negotiations about the Reformation of regulations. The standard lease is still a work in progress but should be ready soon. In the meantime practices should not sign any lease without checking with the LMC and their own independent legal advisers.

There was a session on new models of care with presentations by Nigel Watson of Wessex and Sam Etherington of Tower Hamlets. Both areas are Vanguard sites with very different structures to each other. However there are some common themes and it will be interesting to see how these things develop, especially given that the funding is only for one year.

CQC have updated their “Myth-busters” and I would advise constituents to make them selves aware of them.  They have also produced a couple of videos about “What to expect when we inspect” which you may find helpful.

The next GPC meeting is scheduled for September.

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

Dr Russell Brown

Friday, March 27, 2015

Career Opportunity of a Lifetime!


EVIL GENIUS seeks minions to sacrifice their lives in World Domination Attempt! Must be prepared to work 24/7 for psychopathic megalomaniac for close to no pay. Messy death inevitable but costumes and laser death rays provided. Absolutely NO WEIRDOS!

But if that doesn’t appeal, we also have the following opportunity:

In Polegate, near Eastbourne, East Sussex, on the border of the beautiful South Downs National Park.

We are seeking a six session Partner to replace a Partner who is relocating due to family circumstances, from 5 October 2015.  Salaried positions with a view to Partnership would be considered. We are keen to introduce further dynamism into our established but forward thinking team.  We are a friendly, well regarded, and high performing GMS Practice of  6,400 patients, served by 4 Partners (3FTE) from two surgeries, both of which have their own bean-to-cup coffee machines.  Both premises are rented with no "buy-in" and prospect of major new development for main surgery in collaboration with neighbouring practice in the next 2-3 years.  No extended hours.

CV and covering letter or any queries to Mrs Anita Taylor, Practice Manager, Manor Park Medical Centre, High Street, Polegate, East Sussex, BN26 5DJ. E-mail


Saturday, March 21, 2015

GPC report for 19 March 2015

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

19 March 2015


The GPC held its latest meeting today. In two parts, the morning was GPC proper with the afternoon being group sessions to discuss the future form and function of the GPC with particular reference to its relationships to LMCs. I discovered this week that in an uncontested election I was returned as your representative to GPC for another three years. I am delighted to be able to continue with this element of my work though I am always a little uneasy about uncontested elections. I have chosen to believe that you, my constituents, think I am doing a good enough job that you are happy to leave me to it and so would like to say thank you for your continuing supportive comments and feedback.


As usual, the first part of the meeting was a report from the Executive Team on recent meetings and negotiations. Much of this focused on the recently announced "pay rise" we have all been given, with a 1.16% increase in funding. It would be fair to say the formula for calculating expenses is pretty hopeless, a fact acknowledged by the DDRB. Work is ongoing to attempt to address the weaknesses of the calculations, as well as pension issues, given yesterday's Budget announcement reducing one's lifetime allowance cap further, which I suspect will catch a large number of GPs (eventually). Standard advice to seek independent financial advice from someone with expertise in the NHS pension scheme/s applies. The returners scheme is still causing problems all over the country, with one example cited of a GP from New Zealand, UK trained but a Fellow of the RCGPNZ who, because of the labyrinthine processes, is unable to start working for six months. Apparently he was advised by someone in NHSE that he could always go and do some locums in A&E while he was waiting!


Discussion was had about the results of the recent GP survey, which had a remarkable response rate. The results are likely to be published in the next few weeks and months but will I have no doubt strongly support GPC's position in discussions with Government. There have also been two patient events, where groups of patients have contributed ideas to what the future of General Practice should be. Results are currently a closely guarded secret but there are several common themes which will be described in due course with the survey results.


A discussion paper on future models of service provision which I had previously been involved in the writing of as Deputy Chair of the Commissioning and Services Development Subcommittee was discussed and will be developed further. GPC will be observing the progress of the 29 vanguard sites with a beady eye. I forget if I mentioned last month that, in Ancient Rome, the vanguard were traditionally slaughtered to a man. I offer this only as an observation on classicism.


A move towards demanding recognition of our craft as a Speciality in its own right is on the cards. Apart from Austria and Italy, we are alone in Europe in not being recognised as such, despite leading the world in the quality and breadth of the training and service we provide. The RCGP are partners in this with GPC, so perhaps news soon.


The afternoon session will hopefully result in a proposals paper being presented to the Annual Conference of LMCs, to be held in May. Fingers crossed.


No doubt the official GPC news will be published shortly. It will be available through the BMA Communities web site. Additionally, the most recent Sessional's newsletter has been published on the BMA website.


I hope you have found this report helpful. Please feedback so that I can ensure my reports are useful. Feel free to email me on if you would like to comment or ask me anything. Comments can also be posted on my blog where this report will also be posted at

Dr Russell Brown


Wednesday, February 25, 2015

GPC report 19 Feb 2015

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
19 February 2015

The GPC held its latest meeting today.  In two parts, the morning was GPC proper with the afternoon being devoted to subcommittee meetings.  I sit on the Commissioning and Services Development Subcommittee. 

The morning session reported on meetings held by the executive team (formerly known as the negotiators) and much of the detail is confidential.  However, meetings have taken place to discuss the Five Year Forward View and how it might be implemented. On the subject of Workload, the Primary Care Foundation has been commissioned to undertake an audit by NHSE.  Although this is unfunded work, it is a worthwhile exercise to gather supporting data and I believe the LMC may be writing to practices soon about it.  Additionally, Northern Ireland GPC have produced a detailed workload analysis in partnership with the Administration.  I am unsure if this will be published but the figures it contains are so compelling that I suspect there will be moves to replicate the work in the other three countries of the UK. CQC have apparently set up a group to examine the so-called intelligent monitoring process and they have once again been advised that it is not fit for purpose. With the regard to the overly simplistic ratings of practices, the BMA have reiterated its opposition to the idea and is apparently developing an alternative which may be more meaningful. I have few details at present but will share more when I can. The recent GP Survey is being collated, after an astonishing 40% response rate.  I understand the results will be presented and debated at next month's meeting. The new BMA campaign No More Games was discussed, calling on all political parties to stop playing games with the NHS.  Apparently the Lobbying Act has had a significant impact on the BMA's ability to advertise the message, but it is being discussed on social media with the hashtag #nomoregames, so by all means check it out and spread the word.

The afternoon session was essentially a single item agenda discussing further the 5YFV and the models of care it proposes.  At this point the conversation, which was very productive, is confidential as it is formulating policy and guidance.  However I will share more details when I can.

No doubt the official GPC news will be published shortly. It will be available through the BMA Communities web site.

Finally, and unrelated to this meeting, the regional elections for GPC for our area will be held soon.  I intend to stand for re-election but if anyone else is considering standing I would be more than happy to be contacted to advise on time commitment etc.  Alternatively, Julius Parker our Chief Executive at the LMC office would also be happy to discuss with prospective candidates.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Please feel free to leave comments. One

Dr Russell Brown

Tuesday, December 23, 2014

GPC report 18 December 2014

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
18 December 2014

The GPC held its final meeting of 2014 today.

CQC was discussed, in the context of the banding and inspection regime.  CQC wish to meet with GPC to discuss how best to move forward.  I am not sure, personally, that moving forwards should be the preferred option.  I maintain that, rather than being not fit for purpose, the CQC is an organisation without a properly defined purpose it could be fit for. Nevertheless, hopefully engagement will result in improvements to an incompetent process.

Co-commissioning guidance has been published by GPC in the last week.  To reiterate my comments of last month, it is absolutely imperative that all GPs make sure they are fully informed and fully involved in this matter.  Colleagues will be aware that six of the seven Sussex CCGS have written to the Area Team expressing a desire to pause until more detail is available, such that their member practices are better placed to make a properly informed decision about the way forward.  This reflects well on the CCGs and their understanding of the need for robust engagement with their member practices.  I was delighted that they were able to listen to their members in a way that some other areas of the country have not experienced.

Work continues on developing a strategy on the thorny issue of "Workforce".  Recent publications by the Centre for Workforce Intelligence and HEE confirm the parlous state of GP recruitment and retention.  A strategy document in draft form was discussed, covering a dozen areas.  For my part, if there was a single thing that could be dealt with (if only life was so simple) it would be workload, specifically reducing it. Without doing that it is difficult to see how we can get the fun back into General Practice and make it a more positive career choice for young doctors. Despite the pressures we face, I can think of nothing I would rather do.  Apart from retire, obviously.   As a result of the debate, the document will be updated very soon.  I will share it when I am able to.

An update on various issues around out of hours and unscheduled care were also discussed.  There seems to be some movement in the understanding of other parties that GPs are just not physically able to take on more to relieve pressure in the system.  This may seem difficult to believe in a week where there have been reports of an ambulance service recommending to patients that they ring their GP surgery first instead of 111, just in case they are open that evening. Such a fundamental misunderstanding of GP shows how far we still have to go.  The duplication of service and uncertainty as to where to go and who to call for patients is the main problem. I hear calls for patient education but I can't see that this is the solution.  Properly thought out integration of out of hours services, placing the patient at the centre of the process, must be the way forward.  Piecemeal, often politically driven bolt-ons will only serve to further muddy the waters.

There are also moves to get General Practice recognised as a speciality in its own right, probably as Family Medicine.  UK GP is so much broader and fuller than almost anywhere else in the world that it is incomprehensible to many of our European colleagues that we, along with Austria and Italy, do not recognise it as a speciality. I won't hold my breath.

Finally, over lunch, I was reflecting about my achievements this year at GPC.  Struggling to think of anything concrete, it was pointed out to me by Julius that in order to measure achievement, one must first know what is being measured.  I felt much better after that.  I am able to share one definite achievement, though sadly not mine: after months of perseverance a colleague, who shall remain nameless, has managed to balance his or her pen on the microphone at his or her desk in the Council Chamber.  I am sure you will all be pleased to hear that I refused to believe this without photographic proof, herewith replicated in all its glory:


The next GPC meeting is to be held on 15th January 2015.  It only remains for me to wish all my constituents seasonal greetings.  I hope we all have a peaceful and prosperous New Year.

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

Dr Russell Brown

Wednesday, November 26, 2014

GPC report from 20 November 2014

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

20 November 2014

The GPC held its latest last week.   The latest official GPC news can be found at the BMA Communities web site and for constituents and LMC members is included with this report.  Unlike last month, though the actual conversations are confidential, I am able to be considerably less discrete than last month.  As a result, this report is almost diametrically opposite to last month’s in its length and, of course, its consequent interest value.  No, really.

CQC and “Intelligent Monitoring”

As I am sure you are aware, the CQC published a frighteningly misleading data set about all practices in England, and classified them into 6 bands of concern.  Band 6 practices are apparently least likely to be putting patients at risk, and band 1 practices most likely. Speaking as a partner in a Band 1 practice, which went through a CQC inspection less than 6 months ago where nothing of any meaningful significance was found and which will be going through another inspection in the next few weeks under the new regime, I was extremely angry that CQC had once again deliberately made statements which they must have known the press would leap upon with glee.  My partners and practice manager were understandably upset.  On the other hand, my patients were either totally disinterested in the CQC’s assessment or horrified that their practice was being pilloried in this way.  I have written to my local paper, the Eastbourne Herald, about the matter.  They haven’t published it yet, so it would appear the local press aren’t fussed either.  

The 38 indicators chosen do not seem to reflect on the quality of care provided by practices as well as being out of date.  GPC was consulted by CQC on the use of the indicators and opposed their use as overly simplistic,  but as is normal the genuinely constructive comments made were completely ignored.  CQC has once again proven itself unfit for purpose, even assuming that its purpose is definable, which I am doubtful of.  You will of course recall that fees are increasing by 9%, which is fascinating given the organisation is not providing value for money by any stretch of even the most fevered imagination.  The GPC chairman, Chaand Nagpaul, has written to both Prof Steve Field, that well-known friend to general practice, and the Jeremy Hunt, the Health Secretary, expressing our anger and dismay.   We are actually fortunate locally that the LMC office has managed to establish such a constructive relationship with the local CQC office, meaning that, to a degree, pragmatism and common sense is being applied.  If you are to be inspected, please notify the LMC office as soon as possible and feedback about your experiences.

NHS Five Year Forward View

The full report can be found here.  Interestingly, much of this document seems to suggest a move in a direction which GPs might consider to be right, as it often focusses on many of the areas that GPC has been working on in the last couple of years, particularly the “Your GP Cares” campaign which calls for long term sustained investment in General Practice.  This can be broadly categorised under funding, workforce and workload (where the document agrees we need to expand the workforce including nurses and other primary care staff) and empowering patients, moving towards more self care and support for carers.  Patient access to information is a strong theme and fits with the recently published long term NHS IT strategy and recently concluded contract negotiations, as well as local schemes such as ROCI and the enhanced Summary Care Record.

However, whilst the document recognises the pressure general practice is under as well as the unhelpful focus on hospital care that has existed for the last decade, it does not provide all the solutions, which is perhaps helpful as it recognises that a “one-size-fits-all” approach is inappropriate.  It is worth remembering that funding for hospitals has increased by over 40% in the last 10 years, whilst in general practice that figure is only about 10%, and that consultant numbers have increased at three times the rate of GPs.  The document talks about breaking down barriers between primary and secondary care, between mental health and health and social care.  Services need to be organised to support patients with multiple conditions, with locally delivered services, whilst recognising that specialist centres can produce better outcomes.  The plan recognises that list based general practice is the foundation of the NHS and this will continue. It also recognises the pressure that general practices is currently under and that there needs to be a “new deal” for GPs.  There is a commitment to invest more in primary care over the next 5 years whilst stabilising the core funding for general practice nationally over the next 2 years.

To this end, new models of care are proposed: 
Multispeciality Community Providers (MCP) will offer a new option for groups of GPs to combine with nurses, other community specialists and perhaps mental health and social care to create an integrated out of hospital care organisation. There are some early versions of this around the country but as yet they have not moved to the next stage of employing hospital consultants, having admitting rights to hospital beds, running community hospitals or taking on delegated control of NHS budgets.
Primary and Acute Care Systems (PACS) – this model of vertical integration combines general practice and hospital services, similar to an accountable care organisation now developing in other countries including the USA.  Many would question what would happen to a practice if their contract was held by a hospital. This option could provide a model for some that has something to offer but would need many safeguards to be put in place.  I suspect this may work in urban, under-doctored areas but is going to be of no use at all in the countryside.

Additionally, urgent and emergency care will be redesigned and integrated between A&E Departments, GP out-of-hours services, urgent care centres, NHS 111 and ambulance services.  There has been a great focus on the pressure A&E is under, with an additional £500m being given to hospitals over a 2 year period to help relieve the pressure,  yet A&E sees 21 million patients a year compared to the 340 million seen in general practice (increased from 240 million in 2004 but general practice has not received additional funding for this increased demand).  Urgent Care Centres refers I think to the emerging model of groups of practices working together in partnership with others such as community nurses, paramedics, social workers etc to cover a larger population than an individual practice.  The current model does not work and there are perverse incentives in the system:  if A&E is paid on the basis of each patient seen and critically ill patients are funded at the same level as minor injuries, what is the incentive for them to stop the minor injuries attending the hospital.  This is an important initiative to reducing the workload on general practice as well as A&E.

It is worth considering that many of our younger, often sessional, colleagues are perhaps ambivalent about our independent contractor status.  Succession planning is something that should be thought of early and frequently and the LMC office is happy to provide advice and support.

But change is coming.  Are you and your practice willing and able to embrace this change and move to a more interdependent model with colleagues in other practices as a means to maintain your independence?  I am also concerned that the persistent failure to change the focus of investment from hospitals to out-of-hospital settings will continue.  Without that nettle being grasped firmly, I do not see how this plan can succeed.


The NHS England report “Next steps towards primary care co-commissioning” was launched on 10th November 2014 and can be found here.  It outlines three models of co-commissioning, NHS England’s plans for resource allocations for CCGs, plans for developing and delivering a new framework on conflicts of interests and the timeline for approval and implementation.  The LMC is holding events on co-commissioning this week.  This idea should not be dismissed out of hand as, if resourced and used appropriately, co-commissioning may be a mechanism to deliver more resources into primary care.  Of course, the entire concept is only necessary because of a botched major reconfiguration of the NHS which is funded inadequately.  

The key features of the three models are described in the report in this table: 

In my view, model C is a nightmare scenario for general practices.  CCGs are membership organisations of GP practices.  The conflicts of interest evident in model C are unbelievable, with a GP-led (apparently) organisation being responsible for the commissioning of general practice.  How can we hold the board of our respective CCGs to account if they are responsible for decisions on investments into our practices? How is this process going to do anything other than create a wide-ranging postcode lottery of service provision? And that in turn risks significant repetitional damage to GPs, who may well be perceived by the public and the press as commissioning with their own self-interests at the fore-front of their minds.  Disinvestment in and decommissioning of secondary care during service reconfigurations could inflame tensions between primary and secondary care, jeopardising service redesign and integration, with the perception of wide-ranging conflicts of interests paralysing the decision making processes and removing clinical input by devolving more and more decision making powers to lay members of boards.

In summary, I am not a fan and would urge you to consider extremely carefully the various options.  CCGs will, no doubt, be canvassing their member practices for views on a way forward.  It is vital that you engage with those processes.

The next GPC meeting is to be held on 18th December 2014.

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

Dr Russell Brown