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

Tuesday, November 24, 2015

GPC Report 19 November 2015

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

The GPC held its latest meeting on 19th of November.  

The meeting began with the news of the junior doctors ballot result, which has provided their leaders with an overwhelming mandate going forwards. The unfortunate intransigence displayed by Jeremy Hunt is unhelpful. Since the meeting I understand that the Department of Health have approached ACAS to demonstrate their willingness to engage.  Whether this is with Mr Hunt's knowledge or blessing I know not. 

The meeting ended (I will return to the middle bit in a moment) with a motion being passed unanimously, with the motion being displayed below in an unusual photo from within the BMA Council Chamber. Ordinarily there are automated sentry guns monitoring use of electronic devices by GPC members, authorised to use lethal force against transgressors.




CQC fees consultation: GPs can apparently not be treated differently to any other providers, and given the Government is removing much funding from CQC as they should be self funding (as in, paid for by us) they have suggested a seven-fold increase in fees, phased in over either two or four years. Given the incompetence of the organisation, the lack of any evidence of benefit whatsoever and the huge cost the very concept of such an increase is staggering.  The DH has apparently found £15M down the back of the Departmental sofa with which to reimburse GPs, but we are not entirely sure either how they have calculated this nor whether that money is recurrent and adjustable for future increases assuming CQC continues to exist in some form. I should perhaps say that I have no idea whether there are any plans to scrap it but I live in hope. In fact I was asked by one of the patient representative observers at GPC what I thought the CQC should be replaced by. I suggested that the millions wasted would be better spent on patient care and supporting services towards excellence rather than wielding a punitive clipboard. Inspection regimes are a waste of time: if you inspect and a service is good, why bother? And if it is bad or worse, you've missed the boat and should have intervened earlier.

The Premises Infrastructure fund is proving interesting. Schemes and payments will be allowed to slip but there is an intention by NHS England to make sure the entire billion is spent but how that will equate to local procedures is uncertain.  Going forward, bids will need to be made by CCGs and not practices.  This does not seem unsensible, as any new building will need to be designed with local needs and priorities in mind.

The escalating costs of indemnity for GPs is a matter of concern not only for GPC but also NHS England and the DH, if only because it is another pressure which will likely stymie their plans if not addressed.  It is being discussed on a regular basis but whether any solutions come of it remains to be seen.

Reducing bureaucracy has taken a step forward with the announcement by Jeremy Hunt recently, as a direct result of conversation between him and GPC representatives, that hospitals will in future not ask for a further referral if a patient fails to attend an appointment. I understand there is to be a clause written into the standard hospital contract, which I am sure will be a great comfort to you all.

A meeting with my own organisation, Resilient GP, was reported. Though we were described as a pressure group when we are actually educational and supportive, the meeting was useful for both organisations and, unsurprisingly, there was to quote Chaand a "staggering amount of common ground”.

A contract working group has been set up by NHS England.  This is not to discuss and sort out the GMS/PMS contracts but to discuss a way forward for the new Multi-speciality community provider models, considering both how they can be contracted to provide services and how organisations such as General Practices might fit into them without there being too much destabilisation.  Indemnity issues have been raised again and there is recognition within the NHS that this will cause significant problems for them if not resolved.  Numerous solutions have been proposed but all come at a not inconsiderable cost.

Negotiations for the GP Contract 2016/17 have begun and almost immediately stopped again until after the details of the comprehensive spending review are formally announced.  Colleagues will be aware of the announcement on Tuesday 24 November of an extra £3.8 billion.  Interestingly, a quick back of an envelope calculation would suggest that, with the changes to National Insurance contributions being brought in, roughly £2 billion of that will head straight back to the Treasury…

A Special Conference of LMCs has been announced, likely to take place in January or February 2016.  The LMC office has already written to practices about it and more details will be shared in due course.  I am sure this will be on the agenda for LMC meetings in the next couple of months.

GPC is also looking at how to encourage more Early career GPs into medical politics, to improve the number of less experienced GPs and motivate and develop the leaders of the future.

There was a discussion about how an activity based GP contract might be made to work, after last yer’s LMC conference passed a motion proposed by Kent LMC suggesting it as a way forward.  I find it difficult to see how this can be progressed, given it doesn’t fit with the current direction of travel espoused by both the DH and Government but it is being examined.

The “official” GPC news can be found at the BMA Communities website. 

The next GPC meeting is scheduled for December. 

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

Dr Russell Brown

Tuesday, October 20, 2015

GPC report 15 October 2015

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15th October 2015

The GPC held its latest meeting on 15th of October.  

Much of the meeting was centred around the beginnings of the contract negotiations for 2016-17, which have started much later than usual. NHS Employers have a limited mandate so far but it may be expanded after the outcome of the Comprehensive Spending Review later in the year. More news when I can. I suspect that discussions will in part be around the recently announced offer by the Prime Minister and we will give serious consideration to how that may affect GPs.  It is likely the experiences of the Vanguard sites will have a bearing on the development of this announcement, which is currently little more than headlines. But as usual, everything is highly confidential and so I can tell you every little. 

Foreign visitors: a new and clarified view of the eligibility of foreign visitors to the UK for Primary Care is interesting. It appears that ANYONE who is in the UK is eligible to receive primary car services for no charge.  There are several issues around this.  Guidance will be rewritten soon and discussions are ongoing with NHS England. For example, where does primary care stop? If a GP requests a chest X-ray for an American tourist, is that chargeable (by the hospital) or not? Information and opinion is also being sought of the indemnity organisations as to whether they cover GPs for providing services for example to American (and therefore potentially litigious) tourists. I should point out I only use Americans as an example as there are no collaborative arrangements in place as there are with many countries. 

A report from the NHS Alliance on "Making Time in General Practice" chimes well with the GPC's existing  "Quality First" work. I understand there will be joint NHSE/LMC meetings to support work towards achieving the suggestions contained in both reports. 

A report by the Health Foundation on quality indicators in General Practice, available here, vindicates GPC's position that any quality indicators used in General practice need to be contextual and that simple scorecards or league tables are at best unhelpful and over simplistic. 

The afternoon was spent in smaller groups discussing what the future may look like and how both GPC and LMCs can continue to represent their constituents. 

The “official” October GPC news can be found at the BMA Communities website. 

The next GPC meeting is scheduled for November. 

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

Dr Russell Brown

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 https://communities.bma.org.uk/the_practice/m/2015-16_gpc_newsletters/286. 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