Thursday, July 25, 2019

Report of GPC England 18 July 2019

GPC England Report
For East and West Sussex LMCs
Dr Russell Brown
18 July 2019

The GPC met this week. I was unable to attend in person as we were short-staffed and so Skyped in.  This was a novel experience for me but enabled me to contribute to the meeting while also managing work flows such as phone calls, visit requests and clinical admin in the practice.  I even saw a couple of patients during the day...

A variety of matters were discussed and I will ask the office to send out the “official” news with this report.

Capita have made known yet another error on their part, having discovered over four thousand unactioned emails in an inbox somewhere, though presumably not in the same draw as the previously reported missing notes.  These date back to 2017 and 71 practices are affected, predominantly in Leicestershire and Lincolnshire.

There are widespread CCG Merger plans going on across the country.  I am aware of it happening in East Sussex.  Please remember that CCGs are membership organisations and that CCG executive bodies should be ASKING you for your views, rather than telling you what they want you to do.  This doesn’t stop them suggesting a course of action but do not feel forced into anything you don’t feel comfortable with.

There were updates on sessional matters from the new Chair of the committee, Ben Molyneaux.   I have known Ben for several years through GPC and he is excellent at making sure GPC does not simply take the contractor view all the time.  I think his election, after his predecessor stood down to concentrate on her role as an LMC secretary, is a very positive thing for our craft generally and sessional colleagues in particular.

There was a Contract item, in which we discussed the implementation of the current year’s contract (essentially confirmation that the necessary changes to Regulations are being placed before Parliament so that they can come into effect from October).

PCNs are now with us and apparently 99.7% of practices are signed up to the DES, with about 25 practices throughout England electing not to sign up.  There have been some concerns aired about the long term affordability of the 30% staff costs which practices will be responsible for going forward, though of course there is much new money coming into the pot to support this new contract over the next five years.  The BMA hosted a PCN Directors’ Conference, which was apparently well-received by attendees.  There are more supportive events planned for the future, though details are currently lacking.  There is a webcast of the plenary talk and summaries available here.  The five service specifications detailed in the contract documents previously circulated are being developed by NHSE and the GPC Exec team over the summer and will be looked at by GPC in the Autumn, I understand.   Additionally, the Investment and Impact fund is in the process of being designed.  Separately, there have been reports from around the country of various management structures viewing PCNs as the answer to a wide variety of system issues.  It is very important that expectations are managed: the new staff in PCNs are to support and address CURRENT pressures IN PRACTICES, not necessarily to be a repository of new work.  That may come in time but we must build capacity and sustainability first.  Once PCNs are properly established and are confident that they are both willing and able to take on new work, negotiations could begin to discuss that.  The LMC is of course able to assist all parties in discussions of that nature.

The OOA (out of area) regulations are being looked at by NHSE.  GPC remains concerned about the effect of cherry-picking and disruption caused by providers such as GP@Hand and Babylon.  That said, the technology of Digital first itself and the issues it may raise, positive and negative, are recognised as something we must get to grips with for the benefit of our constituents, who of course include those GPs who choose to work in and for companies such as Babylon.  In my view, their products are a potential solution to a poorly defined question.  I think NHSE would do well to define the question they are trying to answer then resource practices, or perhaps PCNS, properly to come up with innovative solutions.  Those may include companies such as Babylon.  Many of us in GP would welcome the ability to utilise tools like these, provided they are properly resourced, both financially and in terms of time. But there must be a level playing field.  Digital first providers should be obliged to register ANYONE who presents to them, as we are.

QOF and QI work has begun, with the models in the seven areas being developed with a view to being negotiated on and agreed in the autumn.  The areas are replacing the current two modules from April 2020 and practices will be expected to work on two of them.  They are:
  • early cancer diagnosis
  • CVD prevention and detection
  • supporting people with learning disabilities
  • shared decision making
  • anxiety and depression
  • anti-microbial resistance including antibiotic prescribing
  • wider primary healthcare prevention

The promised Vaccinations and immunisation review has started.  I won’t bore you with details of it yet but this is a Good Thing™ for general practice.  The review should conclude in the Autumn and the results of the review should feed in to the negotiation process in due course.

GPC also continues to engage with NHSE’s Access review, in which we have expressed considerable concern about some of their suggested aims.  Essentially, they wish to reduce waiting times, develop a comprehensive offer for out-of-hospital care including times when practices are not open and look at workforce to ensure resources are used sensibly and thus reduce pressure on and improve services.  Forgive my cynicism, but the word “hospital” seems to loom large by its absence in several of those aims...

Pensions were discussed, with the current pressures being faced by a variety of GPs as well as other members of several branches of public service.  It can be summarised thusly:  the situation is absolutely ludicrous and Government thinks we should just suck it up.  If you haven’t had professional advice, can I suggest you get some sooner rather than later, as an annual additional 5-figure tax bill is rather unpleasant to receive.

Finally, there was a brief item about the NHS Campaigns that you will recall we are now contractually obliged to advertise.  They are basically mostly the patient-facing bits of the items above.  I am sure there is a notice board somewhere in your practice just begging for a new poster.  When they are sent out, obviously.

finally, a plug for the LMC’s annual conference, “General Pratcice: Powerhouse of our NHS”, to be held on Wednesday 2 October at the Aurora Hotel in Crawley.  The speaker list is impressive and you will no doubt be delighted to hear it does not include me.  To sign up, please go to the LMC website at this link.

The next meeting GPCUK in September. 

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

Dr Russell Brown

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