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.

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 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.

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

Thursday, April 21, 2016

GPC report 21 April 2016

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

The GPC held its latest meeting on 21st April.

NHS England published its "General Practice: Forward View" on the morning of GPC and it formed the major part of the morning session.  It can be found on the NHSE website.   There has been significant input from GPC and work that has been ongoing has been incorporated into the document by NHSE. Nevertheless, although there is much in it which is of promise, the devil is in the detail which is apparent by its absence and the money, though seemingly a large amount, would seem to be inadequate for what is needed.  For this reason, the BMA and GPC declined to "cobadge" the document, a position at variance with that of the RCGP.  It is certainly a starting point and an acknowledgement of the crisis that exists but it is not a rescue package that would be recognisable to most GPs. GPC will engage with NHSE to thrash out the necessary details.  An email has already gone out from Chaand Nagpaul to GPs which is available on the BMA website.  As you might imagine, I have my own views on the document but I would be interested to hear your views so I can properly represent them during discussions at GPC.

The afternoon was taken up considering a report by the GPC reform task group, chaired by previous GPC chair and chair of BMA council Hamish Meldrum. You may recall an extensive and lengthy piece of work has been going on to consider reformation of GPC and how it interacts with and answers to LMCs. This work is near completion and the report will be published next week, with a commentary from the GPC executive team generated by this afternoon's debate, in time to go out with the documents associated with the forthcoming Annual Conference of LMCs. Many of the recommendations require discussion at Conference or by the wider BMA before moving forward.  Some require changes to standing orders and bylaws of the Association. However, several are in the gift of GPC and were decided on at the meeting.  Details are currently embargoed until the paper is formally published. That being the case, there may be a short addendum to my report next week with more details. If anything more illuminating is released from the centre before then, I will let you know.

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

Dr Russell Brown

Thursday, March 17, 2016

GPC report 17 March 2016

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
17th March 2016

The GPC held its latest meeting on 17th of March.

This month's report is, you might notice, short. There could be several reasons for this, including fatigue, ennui, complacency or irritability. However, because the meeting this month was short, being a morning only with subcommittee meetings in the afternoon and because much of the meeting was considering matters which must currently remain confidential there is little I can say.

We were however joined by Dr A Lupo, the President of UEMO, who described how primary care was in his home country of Italy, where family doctors (independent contractors in the main) are in dispute with their government and who have recently postponed a 48 hour strike to allow negotiations to proceed. 

There was a presentation about DevoManc and how it is moving ahead. It was noticeable that there is much risk involved and that, although we were reassured that GPs are fully engaged, local GPC reps have a different view.

An update on the Urgent Prescription for General Practice campaign was given by Beth McCarron Nash.  It has apparently been quite successful, though I am unclear by what measure. It, together with the Quality First documents, are to be commended to you as they assist you in protecting yourself in various ways.

In the afternoon, the subcommittee I sit on, the Commissioning and Services Development Subcommittee, met.  Unfortunately it mostly discussed specific parts of the same issue as the morning which I am unable to report and so, like the information from the morning session, I am unable to report it. 

And that is, my friends, about all I can tell you from this month!  The next meeting will be in April, with the Annual Conference of LMCs being in May. 

To sign off, I will abuse my position to remind you of a survey being run by my organisation, Resilient GP in collaboration with both GP Survival and Londonwide LMCs, on a suggested rescue package for general practice. At the time of writing it has attracted over 2400 responses (in less than four days).  I would be delighted if you would consider completing the survey, which is not meant to provide any statistically significant output but be a cause of conversation in the corridors of influence. And as several people have asked me about the correct way to rank the questions, please consider whether the most popular song in the charts is called "the number one in the pop parade" or not.  Thank you very much! 

Happy Easter or indeed any other festival you may choose to celebrate or indulge in!

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

Dr Russell Brown

Monday, December 21, 2015

GPC report 17th December 2015

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

The GPC held its latest meeting on 17th of December.

As ever, much of the contract negotiations information imparted to us is confidential. However it is worth noting that the NHS £3.8 billion increase announced in the comprehensive spending review has at least a proportion coming to general practice. Details of how this will be spent are as yet unclear.  Colleagues may be aware that already £1.8 billion has been ear marked to essentially bailout acute trust deficits.

Scotland on the other hand have concluded their negotiations with QOF moving into core payments in 2017. Indeed there is much that could be admired and indeed emulated in the Scottish agreement.

A survey undertaken by the BMA on the primary-care infrastructure fund found that the situation is fraught with delays and threats even to funding approved schemes. There seems to be some difficulty with NHS England realising that they need to be funding revenue costs going forward rather than simply providing a pot of money at the outset

Indemnity costs have been considered but seemingly only superficially: £2 million has been ear marked by NHS England to help offset the costs of working in an out of hours setting this winter. It is unclear how this will be allocated presently but no doubt that will occur seamlessly and with an elegant simplicity. This obviously won't help in the longer term.

A Multi-specialty Community Provider contract advisory group has been set up. This is not to design a new GP contract but rather to try and properly formulate the environment in which MCPs will work. The presence of the GPC on this group has been moderately effective in emphasising the need for how any contracts will affect primary care to be addressed. The group does not appear to be hostile to general practice.

The atrocious comments written by Professor Steve field in the Daily Mail has resulted in a vote of no confidence by GPC. I have no doubt that, satisfying as it is, absolutely nothing will happen as a result. I understand the Royal College also posted a highly critical response. Quite how he thought this would improve the standing of CQC in the profession's eyes is beyond me.

The Special Conference of Local Medical Committees will occur on 30 January. By the time you read this motions will already have to have been submitted by the LMC. We will see what the agenda committee make of everything but I anticipate that there will be half a dozen themed debates during the day.

In the afternoon there was a presentation by Dr Arvind Madan, the new Director of Primary Care at NHS England. His previous work experience includes being a partner in the Hurley group and being an owner of WebMD. I understand his conflicts-of-interest have been appropriately managed since his appointment in the Department of Health. The presentation was apparently confidential though nothing was said that is not already in the public domain. Given there is a degree of agreement between NHS England and GPC, there was no surprise that much of what he spoke about was to do with workforce and workload. After his presentation there was a question and answer session during which the inestimable Dr Katie Bramall-Stainer from Hertfordshire was extremely clear with him exactly what we all thought. Unaccountably, he was not at the traditional post-December GPC mince pies and mulled wine event.

During the afternoon 4.2% increase in funding for general practice each year for the next few years was announced by NHS England via Pulse Today. Although this has been trumpeted as something of an improvement it actually simply allows us to standstill at current levels of funding taking inflation into account.

The current edition of the official GPC news is available at the BMA communities website here.

Other than that I hope you all have a peaceful and satisfying festive season, however you choose to celebrate it. All of us will be working for at least some of the time over the Christmas period, at a time when many of our patients will no doubt be grateful for our presents (sorry, that was appalling). I am keeping my fingers crossed for an improved 2016!

The next GPC meeting is scheduled for February.

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