NHS England takes action to ease pressures on general practice and provide joined-up care

NHS England today agreed new steps to implement plans to strengthen general practice, ease the pressure on GPs and improve services for patients.

The measures aim to help struggling GP practices, protect GPs from the rising cost of negligence claims and introduce new models of care that will create more joined-up services.

It follows the publications in April of The General Practice Forward View, a five year programme that aims to put General Practice on a sustainable footing for the future.

The full NHS England Board at its public meeting this morning agreed a package of immediate actions including:

  • Release the first £16m of the new £40 million Practice Resilience Programme, a key part of the five-year General Practice Forward View, to help struggling practices across the country.
  • The first phase of the three-year, £30 million general practice development programme, which will give every practice in the country the opportunity to receive training and development support.
  • New funding to fully offset the rising cost of GP indemnity, and wider plans to reform indemnity arrangements

Simon Stevens, NHS England chief executive said: “We meant it when we said we would take concrete action to help relieve pressure on GP practices, and today’s funding is just the first instalment. Practices need support, now, and a few weeks on from the GP Forward View we’re getting on with practical action to do so.”

Dr. Arvind Madan, a GP and NHS England Director of Primary Care, said: “Three months on from the launch of the General Practice Forward View, we’re now getting on with implementing these plans. We understand the pressure on GP practices and today’s announcement shows how we’re getting on with immediate practical steps to deliver GPs much-needed support.”

On the £40m Practice Resilience Programme, funding will be released this week in order to quickly secure help where it’s needed most. This new scheme builds on work underway since December to help those practices worst affected by rising patient demand and will allow a wider range of support to be delivered.

This support will include practical help to stabilise practices under most pressure and for those practices with workforce issues. This will include access to specialist support on HR, IT, staffing and practice management. Importantly the offer is not conditional on matched funding.

NHS England’s local teams will manage the funding as it will allow support to be developed and targeted more closely to practices or groups of practices where support is needed most.

This builds on the extra funding for indemnity expenses built into the 2016/17 GP contract agreed with NHS England and the General Practitioners Committee.

On indemnity, NHS England has worked with the profession, medical defence organisations and the Department of Health to develop a twin track approach. A new Indemnity Support Scheme for practices will be introduced in April 2017 for at least the next two years while the Winter Indemnity Scheme will run for a further year.

Secretary of State for Health Jeremy Hunt said: “We want the best working conditions for GPs so that they can provide the best service for patients. We have listened to concerns and know that for GPs, paying rising indemnity fees out of their own pockets feels unfair and unsustainable – so are today committing millions to help.”

Practices can now register Expressions of Interest in joining a local Time for Care programme as part of the £30 million general practice development programme. National expertise and resources will be available for every practice in the country to have a 9-12 month series of workshops, learning sessions and agreed action plans. These activities will help practices to implement their plans to help release capacity and work together at scale, enable self-care, introduce new technologies and make best use of the wider workforce, so freeing up GP time and improving access to services.

Previous experience shows that most practices could expect to release about 10 per cent of GP time over the 9-12 month period.

Today’s announcement builds on recent developments, including an invitation to providers to tender for a new multi-year ‘NHS GP Health Service’ for GPs suffering from mental health issues like stress and burnout. It will also support GPs wishing to return to clinical practice after a period of ill health.

To support doctors who might otherwise leave the profession to remain in clinical practice NHS England has increased, through the Retained Doctor Scheme, both the money for practices employing a retained GP and the annual payment towards professional expenses for GPs on the scheme.

Along with NHS Improvement, NHS England is also writing to all NHS Trusts, Foundation Trusts and CCGs to remind them of the standards now in force as part of the NHS Standard Contract, including not automatically asking GPs for re-referrals for did-not-attend outpatient appointments into the care of a GP.

The new legal contract requirements in the NHS Standard Contract for hospitals in relation to the hospital/general practice interface came into force from April. These set new standards for interactions between hospitals and practices.  With NHS Improvement, we are today (28 July 2016) writing to all NHS Trusts, Foundation Trusts and CCGs to remind them of these requirements which will help both patients and practices.  We have also established the new Working Group involving the GPC, RCGP, RCP, NHS England and NHS Improvement that will drive further action to improve the current interface between primary and secondary care.

NHS England is also announcing further details of the multispecialty community provider’ (MCP) care model framework, which includes proposals for how the new voluntary contract may work. It proposes the contract will be a multi-year contract with payment operating on the basis of a whole population budget, a new pay-for-performance incentive scheme and risk-and gain-share agreement with the acute sector.

The pay-for-performance element will replace the Quality and Outcomes Framework (QOF) and Commissioning for Quality and Innovation (CQUIN) and should ensure that payment is based on outcomes delivered across multiple care settings and not based on individual episodes of care. In addition, a risk-sharing agreement with the acute sector means that the MCP will share the gains from reducing unplanned hospital admissions – for example by investing in faster primary care appointments.

This new whole population budget sits at the heart of the model. It is based on the GP registered list and covers a much wider range of primary and community-based services, and potentially aspects of hospital-based care. In practice, this means the MCP ultimately holding a single contract for all services in scope, including primary and medical community health, social and mental health services.

This greater level of flexibility will transform the way care is delivered. The framework, which will differ across the country to reflect the needs of local communities, includes better signposting, alternatives to face-to-face appointments and integrated access.