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£10 million investment boost to expand general practice workforce
Health leaders have today (Monday) announced a £10 million investment to kick start a new plan to expand the general practice workforce. The money will be used to recruit new GPs, retain those that are thinking of leaving the profession and encourage doctors to return to general practice to better meet the needs of patients now and for the future.
NHS England funding will be used to develop a range of initiatives in collaboration with Health Education England (HEE), the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) to increase the number of GPs and develop the role of other primary care staff such as nurses and pharmacists.
- To recruit newly trained doctors into general practice in areas that are struggling to recruit, we will incentivise them to become GPs by offering a further year of training in a related clinical specialty of interest such as paediatrics, psychiatry, dermatology, emergency medicine and public health. This work will be underpinned by a national marketing campaign aimed at graduate doctors to highlight the opportunities and benefits of a career in general practice. Alongside this, pilot training hubs based in GP practices will be established in areas with the greatest workforce needs to encourage doctors to train as GPs in these areas. They will also enable nurses and other primary care staff to gain new skills.
- To retain GPs the plan includes establishing a new scheme to encourage GPs who may be considering a career break or retirement, to remain working on a part-time basis. It will enable practices to offer GPs the opportunity to work with a modified workload and will be piloted in areas which have found it more difficult to recruit. There will also be a wider review of existing ‘retainee’ schemes.
- To encourage doctors to return to general practice HEE and NHS England will publish a new induction and returner scheme, recognising the different needs of those returning from work overseas or from a career break. There will also be targeted investment to encourage GPs to return to work in areas of greatest need which will help with the costs of returning and the cost of employing these staff.
The plan is part of the NHS Five-Year Forward View, which set out a specific commitment to tackle workforce issues. The £10 million is part of the recently announced £1 billion additional investment for primary care infrastructure, announced last week which over the next four years will improve premises, help practices to harness technology and give practices the space to offer more appointments and improved care for the frail elderly.
Simon Stevens, Chief Executive at NHS England, said: “Primary care is the bedrock of the NHS and the Five-Year Forward View makes clear that it will play an even greater role in the future. We need greater investment in GP services, extending to community nursing, pharmacy and eye care services. This £10 million will kick start a range of initiatives to drive that forward so every community has GP services that best meets its health needs.”
Professor Wendy Reid, Medical Director and Director of Education and Quality for Health Education England, said: “This programme will spearhead a completely new cultural change within primary care, supporting a wider multidisciplinary team to work together by emulating successes in emergency medicine for the benefits of patients across the NHS.
”One innovative solution currently in planning is the development of regional training hubs, bringing together the wider expertise of doctors, nurses, pharmacists and other specialisms tailored to the regional needs of patients locally. All of this underpinned by a more equitable and easier career route within a highly rewarding part of the NHS.”
Chair of the Royal College of General Practitioners, Dr Maureen Baker said: “This action plan is good news for general practice and good news for patients. By tackling the three Rs – recruitment, retention and ‘returners’ – this action plan gives us a real chance to build up the size of our GP workforce that our nation needs. General practice has been under great stress for the last decade, which has meant that family doctors have not been able to deliver the level of service to their patients that they have wanted.
“By rolling out the action plan, we are laying the foundations for a fully reinvigorated and restored general practice, which can deliver excellent patient care in the community and take substantial pressure off our hospitals. We hope that this will be the start of more sustained investment for general practice that will help us reduce waiting times for GP appointments, provide more flexible opening hours and provide more services for patients closer to home.”
Dr Chaand Nagpaul, Chair of the BMA’s General Practitioner Committee, said: “At a time when GPs are under extreme pressures due to rising workload exceeding capacity, this funding has the potential to be an important first step towards increasing GP numbers. It is positive the recruitment, retention and returners programme has the endorsement of both NHS England and Health Education England, together with kick-start funding, as a signal of central support for general practice as a career. It is vital that these measures, including commitments to increase recruitment and improve retention are implemented rapidly, not least as these were key parts of the 2015/16 contract negotiations agreed between NHS England and the BMA GPs committee.
“It is also encouraging that after prolonged lobbying by the BMA, NHS England have formally agreed to work with the BMA GPs committee to expand the infrastructure of general practice to include premises”.
This funding will kick start the 10 point plan which has been developed in addition to existing work to increase the general practice workforce. This includes work by Health Education England alongside NHS England and the RCGP to get an additional 4,900 trained GPs by 2020 (compared with 2012).
The workload is overwhelming. In the last 12 months, our consultation rate has gone up by over 100%, we’re bogged down by petty bureaucracy (“yes, all the information that we need is there, but you’ve done it on the wrong-coloured form”), and we haven’t had a pay rise in real terms for 8 years so we can’t afford to employ more doctors, nurses, nurse practitioners or anyone else.
I’m a GP aged 56. I have had to protect my pension as I’m approaching the old pensions cap, and I note that the pensions cap has been reduced again in the last budget. This means that my take-home pay remained the same when I deduced from working 5 days per week to working 3 days per week.
My partners will hit the new pensions cap in their early 50s, and are likely to be forced to similarly reduce their hours. How will you encourage me and my partners to stay in general practice for a minute longer than our 60th birthdays, when we can collect our pensions? More money taxed at nearly 70% (when you include employer’s and employee’s NI contributions? A better pension?
My father retired as a GP in his mid -70s. My generation will get out as soon as they can.
Train more GPs? One hospital locally has had ZERO applicants for their GP training posts.
Many GPs, like myself, will have retired, voluntarily removed themselves from the Medical Register and moved on – house, home and even country. How will the NHS find them, assess their capability of resuming practice, defend them, arrange supervision to bring them up to date etc? I can’t see this having a significant impact on GP numbers.
Good idea- how about investing in more nurse practitioners in primary care? This all seems to centre around GPs (much needed of course). Train AND pay nurses appropriately and there is a lot we can do to alleviate the surgery workload especially with regard to minor illness/injury and chronic disease management which forms a large part of the workload. With proper mentorship, training and pay much could be acheived. The whole NHS system needs a radical rethink and overhaul
I agree with some of the comments made, especially around – is this new money? Will this simply help to replace the retiring GPs?
I apologise for the statements below – however, they are a view that needs to be discussed openly – and not treat as a white elephant in the room.
We have always tried the carrot approach to retain GPs and encourage more to join in.
Have we really tried to find out if our system of training is conducive to recruiting more GPs all of a sudden – because the politicians decide it is the thing to do straight away?
Have we as a nation (not the NHS, not the RCGP not the DH not the BMA) wondered and tried to fathom out, why GPs wish to leave the NHS when they reach their mid or early fifties?
Probably multiple factors including, increasing work loads, extensive regulatory pressure etc etc.
However we forget an important aspect – That the GPs when they leave practice will be able to cash into
1. Partnership profits – by selling their stake
2. Enjoy a very generous pension
General Practice is the only area of work any where in the world – yes any where in the world where:
One gets paid a guaranteed sum simply to meet and greet the patients (everything else after that is paid for additionally either via LES or similar such mechanisms). It is the truth that there is no clear definition of what a GP is meant to do to earn the guaranteed sum per registered patient.
One can continue to be an independent business man/woman, accept or reject work as an independent business, but be guaranteed a very generous state pension!
Can we put some constraints around the pensions?
Why should a private provider be assured a state pension?
May be it is time to truely privatise general practice – payment by results (not activity – remember Outcome focussed) and no state pension.
Then let the best and the most willing join the system.
These new recruits will be motivated and will want to deliver the best, including out of hours care – thus helping reduce the pressure on our A & Es and creaking hospitals.
As well as trying to improve the GP/patient ratio, we should also be looking at other clinical roles. Physician’s assistants, Nurse Consultants, and expanding the role of Advanced Nurse Practitioners, as examples. Just as we looked outside our borders for different ways of managing emergency care, so we should do for primary care provision; COULD we do things differently, so that patients receive improved care with more continuity, whilst retaining our clinical staff?
Personally I like the model developed in Skipton where a practice has employed 4 physicians associates (PA) to help triage the work in their practice. Effectively a single GP can “see” 3 times the usual workload. Also invaluable in OOH work.
Since its a “new ” workforce they dont have to steal advanced nurses from elsewhere in the system to provide the service and they are also significantly cheaper than GP’s and yet allow the GP’s within the practice to be much more efficient.
The use of PA’s in acute care is also something that may offer solutions to the depletion of junior doctors.
Whilst no doubt worthy objectives, I fear they will do absolutely nothing to solve the crisis that already exists in General Practice. It was heartening to hear that NHS England said during the latest hospital bed crisis that it was acceptable for routine operations to be cancelled as it it was right to concentrate on the acutely ill.
Well, Primary Care is acutely ill and like Ebola there is no imminent cure and if it get worse the consequences will be enormous.
I wholeheartedly support anything that allows GPs and Practice Nurses to get on with seeing ill patients first and then they deal with the more routine work. For example: drop QOF, CQC, Appraisals, all DES and LES work. Halt the ongoing unfunded transfer of work from hospital to primary care, slash the compulsory use of forms (what other profession, I wonder, insists on only using a certain format to allow intra-professional contact).
This could happen overnight and would make an instant difference. Then I support the longer term objectives although there needs to be a lot of meat on the bones so far offered. And if NHS England really believes in Primary Care and the Partnership model it must do more to support this model. Yes, it will involve talking about money. As the RCGP keeps pointing out the proportion of NHS spending in Primary Care is at its lowest ever level. Finally, if there truly is a desire to retain GPs in there 50s (like me) then it will involve a real financial incentive too. No pay rise for 8 years. How much has MPs’ pay risen in this period?
As a GP appraiser and approaching 55 yrs I can see both sides of this. I know that many of my GP appraisees fear appraisal significantly, yet I have not heard hopsital doctors complain about it. think the reasons are twofold – 1. As GPs we are simpoly not used to it, and it feels threatening (whereas hospital doctors have been familiar with appraisal for years. 2. Unlike hopsital doctors who have specifically identified time for CPD and service development, as GPs we have tended not to protect time for such clinical governance activities, so we find it harder to gather the required materials. yet done well GPs often find their appraisal has been a formative and useful exercise and a real opportunity to reflect on the previous year and plan the one ahead.- when else do we get 2 hours of protected time to talk just about ourselves? , NHSE and GMC take note – appraisal must never lose its formative aspects and become merely more box ticking.
The extent to which the job has become stressful these days is phenomenal. I have seen an increasing proportion of able committed high functioning GPs of my age for their last appraisal before retirement. I find my thoughts turning to retirement often, but its not appraisal that makes me want to leave, its the endless demands of the job itself. If NHSE want to retain numbers they should look at every change they make from the GPs point of view – from 111 to the reductions in District Nurses and health Visitors, Unplanned admissions initiatives, Dementia screening and thate taking out of service senior and able GPs for up to 3 days a week to run the CCG, I can never see that anyone at the DH or NHSE or whoever is running the show these day has properly considered the impact on GP time.
No mention of non clinicians who support the processes, allow GPs to focus upon the patients and not the bureacracy needed to support it all. Practice Managers have the same demographic mix as their GP partners/employers – loss of either/both impacts upon care!
Where is the investment for nurses in this plan? They are mentioned but general practice cannot develop unless the investment is focussed on the whole team. Where would general practice be without the nurses – who would be extending the clinics to see all of the patients? If more money was invested in the nurses in general practice; in education and development; in career pathways; in developing leadership and investing in recruitment to support the inevitable retirement of our experienced nurses, then we could work alongside the GPs and make general practice a place where new nurses want to work and want to stay. I am disappointed in this 10 point plan – why is the focus on GP’s alone – there is no one role more important than another in the world of general practice.
This ‘investment boost’ represents less than 2p per patient. Is this even new money?
As a 55 year old GP who is just counting off the days to leave the NHS there is nothing in this which would make me stay whatsoever. The RCGP has been instrumental in destroying GP in this country and this is yet more.
How about getting rid of appraisal, bringing back seniority payments, dumping QoF, stop slagging us off in the press, and actually giving us a pay rise?
That might just encourage some of my generation to stay.
Don’t want to do that? Well, reap the rewards.
How many more doctors will be trained?
This 10 point plan is designed to complement existing work to increase the general practice workforce including work by Health Education England, alongside NHS England and the RCGP, to get an additional 4,900 trained GPs by 2020 (compared with 2012).
Risible. Irrelevant. Fatuous.
I am leaving my GP job, and Medicine very shortly, age early fifties; this nonsense clearly confirms that docs like me are not wanted. The endless pointless bureaucracy is turning us into demotivated box-tickers.
Appraisal and Revalidation is the last straw; dumping this time wasting farce would free the equivalent of appointing 500 full time GPs, and actually save money.
I see there is no mention of using patients to help develop a curriculum that will instil greater respect for GPs.