Tuesday, November 20, 2018

GPC report for 15 Nov 2018

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 November 2018

The GPC met this week.  It was my second meeting this year after a period of absence from work for family reasons.  I am back in the saddle now and all is well.  

There was much time spent on Contract negotiations which are proceeding and I hope to be able to report more soon.  Suffice to say that there is much uncertainty as to long term planning in the NHS as a whole.

There was a lively debate about future ways of working, including Primary Care Networks and Integrated Care Systems, the latest buzz-phrases but towards which we are all moving.  My own feeling is that, essentially, this is the product the NHS wishes to purchase from us and so we should engage with LMCs central in the process so that we can help GPs develop matters to the benefit of patients.  As sure as eggs is eggs, if we leave it to others, they’ll muck it up and damage us in the process.  The fact that the benefits are nebulous and currently have no supporting evidence of benefit whatsoever seems to be an irrelevancy. For what it’s worth, we keep pointing this out, but apparently it will all be wonderful in the new systems.  Who knows?

There was an extensive update from the executive team and policy leads and I will ask the LMC office to attach those documents to this report.  GPC News is 4 pages long.  The Exec and Policy lead document is 14 but is worth at least a skim read to find info that may be relevant to you personally.

The next meeting is Friday 23 November, the LMC England Conference in London, which I shall be attending in my GPC capacity.  After that, we have GPC England in January and GPC UK in March.  You may recall there are fewer meetings now.  I am still unsure whether this is a good thing or not, to be honest.

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

Dr Russell Brown

Tuesday, March 20, 2018

GPC report 15 March 2018

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 March 2018

Since my last report in January I am delighted to report you have re-elected me for another three years. I was unopposed, so no actual election took place.  That either means you are in the main happy with how I represent you or that you don't think there's anyone else you'd rather represent you. At least, that's the two options I prefer to consider. Nevertheless, I take the representative role seriously and so would encourage anyone interested to speak to me or Julius about either the GPC visitor scheme or other routes to election. And of course in three years, if you think you could do the job, I would encourage you to stand.

The GPC met on Thursday in Edinburgh.  This was a GPCUK meeting but the day began with an extraordinary GPC England meeting to discuss the progress of contract negotiations. I have delayed my report until details were published.  These can now be found via the Bma website.

Update from the exec team and policy leads:
In the same new format as January, we were provided with a written update from the executive team and policy leads.  A slightly edited version will be published early next week for LMCs. I will ask the LMC office to forward it on when it is released.  It is fairly long but provides much more information that such reports did previously. I find it very helpful but please feedback if you have any comments on it.

Dr Bawa-Garba and the GMC: there have been several meeting between the BMA (led by the Junior Doctors' Committee) and the GMC.  The GMC have made several pledges which can be found on the BMA website here.

Model locum T&Cs are being developed to assist both locums and practices in avoiding and resolving any problems and will provide equal protection for both parties.

We received updates from Wales, Scotland and Northern Ireland.  The situations are very different but just as challenging as in England. The Secretary of State wishes to undertake a Partnership model review, and the BMA will be one of the main contributors.

The Information commissioners in all four counties are working on final guidance.  The GPC will shortly be publishing adaptable templates for practices' policy posters.  I understand that GPs will be able to act as Data Processing Officers.

Following on from the themed debate at LMC Conference in Liverpool the week before, GPC discussed the Workload recommendations.  Hubs are still a popular model but are not without their issues.  Given the shortage of GPs generally and the often skeleton staff employed out of hours, it is difficult to see where clinicians manning the hubs are going to be found. Additionally, all these pathways of care are often confusing enough for us, never mind our patients.  As I may have mentioned before, we need demand management as otherwise workload management is going to fail. Compared to elsewhere in Europe, we see patients far more often per year for similar health outcomes.

We also had policy group meetings in the afternoon, essentially the old subcommittee meetings. In the Working at Scale Policy group that I work in, we discussed the STP agenda and our concerns with it as well as discussing pharmacists, allied professionals and the difficulty of making a success of things when agendas of different parties fail to mesh.

Separately to GPC I have been working within the BMA on a work stream called "Living our values", a response to some historical concerns about the way in which relationships within the BMA are managed.  In particular, trying to assist committee members to see that their behaviour may cause difficulties for others, given that there are often unconscious biases which may disadvantage certain groups such as women. This is a work in progress.  I am hoping it will lead to better, more inclusive and representatives policies within the Association.

The next GPC meeting is in May, a GPC England meeting being held in London.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 
Dr Russell Brown

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.

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.

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:

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-

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.

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.

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