Last reviewed 2 May 2016
Christine Grey discusses the roadmap for primary care in England for the next five years set out by NHS England Chief Executive Simon Stevens. It commits to increased funding and a national sustainability and transformation investment package to support GP practices.
The General Practice Forward View pledges an extra £2.4 billion a year to support general practice services by 2020–2021, so that spending will rise from £9.6 billion in 2016–2017 to over £12 billion by 2021, constituting a 14% real terms increase.
It will reverse the trend that has seen general practice receive an increasingly smaller percentage of the NHS budget over the past decade. General practice will now get an increase in the budget share from just over 8% this year to more than 10% by 2020.
Launching the plan, Simon Stevens said: “If anyone 10 years ago had said: 'Here's what the NHS should now do; cut the share of funding for primary care and grow the number of hospital specialists three times faster than GPs, they'd have been laughed out of court. But looking back over a decade that's exactly what's happened.”
Over £500 million will be put in place by 2020–2021 as part of the £2.4 billion uplift to enable clinical commissioning groups to commission and fund extra capacity across England so that, by 2020, everyone has access to GP services, including “sufficient routine appointments at evenings and weekends” to meet local demand.
There will also be a one off five-year £500 million “national sustainability and transformation” package to support GP practices, which will be used to support a £56 million “practice resilience programme” to prevent burnout and support GPs suffering with stress, to boost the medical and non-medical workforce and provide support for practices to redesign services.
As well as outlining investment plans, the roadmap addresses efficiencies to relieve GPs’ workload, steps to grow and develop the workforce, how infrastructure and technology will be modernised, and care redesign.
Simon Stevens said the funding increase for general practice should make it easier to recruit more GPs and achieve the pledge made in the Five Year Forward Review, published in October 2014, to take on 5000 additional GPs by 2020. New incentives are set out for training, recruitment, retention and return to practice, in addition to a promise of 3000 new, fully funded practice-based mental health therapists. The programme should result on average in a full-time therapist for every two to three typically sized GP practices.
The plan also promises an extra 1500 co-funded practice clinical pharmacists, and nationally funded support for practice nurses, physician assistants, practice managers and receptionists.
At least 500 GPs should be attracted back or retained in general practice through steps to simplify return to work routes and financial incentives targeted at under-doctored areas.
Addressing workload issues, the plan sets out a practice resilience programme to support struggling practices, and changes to the Care Quality Commission inspection regime so that practices rated good or outstanding will only be inspected every five years to reduce administrative burden. Support will also be provided for GPs suffering from burnout and stress.
One area of workload that will be reduced is where GPs receive automatic hospital re-referrals. Hospitals will no longer be allowed to automatically discharge patients who do not attend an outpatient clinic appointment back into the care of GPs for re-referral. Hospitals have also been advised that they will be able to make “onward referrals” of patients to other parts of the hospital so that this process does not fall back onto GPs.
NHS England will review requirements for GP training in areas such as fire safety and complaints handling to ensure (a far more proportionate approach) is taken, together with the impact of appraisal and revalidation requirements.
Supporting these measures will be a new three-year national programme called “Releasing Time for Patients,” with £30 million funding, to introduce new ways of delivering care, such as telephone consultations or different use of other professionals in primary care.
There are plans to allow up to 100% reimbursement of premises developments, direct practice investment in technology to support appointment, consultation and workload management systems, and better record sharing. The plans rule out calls for crown indemnity but they do say the Government will consult on proposals for providers operating in new models of care to take on corporate indemnity so that individual GPs no longer have to take out personal cover.
The Royal College of General Practitioners and the British Medical Association (BMA), who have been warning about the strain on primary care services in England, welcomed the plan as “a huge and important step in the right direction” and “a significant and comprehensive package of proposals.”
BMA’s general practitioners’ committee chair Dr Chaand Nagpaul welcomed the package. He said: The General Practice Forward View represents a significant and comprehensive package of proposals to support general practice both in the immediate and longer term, the most that we have seen since 2004.
“Crucially, NHS England have committed to investment which will reverse the unacceptable decline in general practice funding. This is a vital step as the proportion of resource in general practice will reach 11% of the NHS budget and beyond.”
NHS England Director of primary care Dr Arvind Madan said: “We are acutely aware of the pressures GPs are facing right now and the need to get on track as quickly as possible. This means that practices, working together, will benefit from access to support if they are struggling to meet patient’s needs, reductions in unnecessary workload, more opportunities to recruit staff and a chance to improve use of their technology or premises.
“We know this is just the start of the journey but we are determined to get this right for the benefit of patients, GPs and the wider healthcare system.”
The General Practice Forward View is available at the NHS England website.