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

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

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

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

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

Career Opportunity of a Lifetime!

Wanted:

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 anitataylor@nhs.net

Website: www.manorparksurgery.com

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 drbrown1970@gmail.com 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 www.thebrownstuff.blogspot.com

Dr Russell Brown

 

Posted with Blogsy

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