The turnaround has begun

Prior to joining NHS England my focus was on growing a group of GP practices across London, mainly comprised of over a dozen struggling practices we turned around.

Each one came with its own history and needed its own unique support package including clinical, financial and operational solutions. It was much harder and took far longer than expected, often because of the prevailing culture in the practice.  Only when everybody involved engaged with the plan did we make progress.

Driven by a better understanding of how general practice can help the wider NHS, a similar approach has been adopted with the General Practice Forward View (GPFV).  Firstly, understanding the history of how we got here and analysing the root causes of the problems. Next, creating engagement, and then starting to put in place a bespoke package of solutions, targeting the key challenges first – namely finance, workforce, workload, infrastructure and caring for patients throughout their journey.

The GPFV provides funding, action on developing the workforce, reforms to reduce workload, investment in infrastructure and support for new ways of collective working. With 80 separate initiatives, it moves beyond understanding the issues to the specific practical actions needed to address them. However, as with an individual practice turnaround, we mustn’t make the mistake of underestimating the scale of the task, how hard it will be and how it long it will take.

We must also keep reminding ourselves that in addition to implementing the GPFV, there’s more to do as well. This is vital to both stabilise the situation and build a new version of general practice that is fit for the future.

Understandably, some argue that the GPFV does not fully ‘rescue’ general practice from all the deep-rooted problems that have built up over a decade. We’ll continue to address this criticism, but practices need support now, and we don’t have the luxury of time while we debate the detail of each element of the package.

At the end of July we began with immediate practical steps to deliver much-needed support to GPs. We released the first £16million of the new £40million Practice Resilience Programme to help struggling practices across the country and announced the first phase of the three-year £30million general practice development programme, which will give every practice in the country the opportunity to receive training and development support.

We also announced new funding to fully offset the rising cost of GP indemnity, building on the £33million invested in the contract the previous year. We’re taking action to improve the Retainer Scheme and to ensure Clinical Commissioning Groups (CCGs) and hospitals are clear on Standard Contract changes which are designed to help reduce avoidable GP appointments related to hospital episodes.

The recently released GP Patient Survey showed the majority of people are increasingly positive about their GP care – with more than 85% rating their overall experience of their GP surgery as good.  The survey found almost four in five patients would recommend their GP surgery to someone who has just moved to the local area.  These statistics show the outstanding job GP surgeries are doing under intense pressure, and are another reason to make sure GP practices begin to feel the support of the GPFV sooner rather than later.

The GPFV is a five-year programme, but in the short-term, it will be judged on how it feels in practices and consulting rooms up and down the land. A GP Oversight Group has been set up to monitor the issues being faced by practices nationally and the progress being made through the GPFV. It includes colleagues from General Practitioners Committee, the Royal College of General Practitioners, NHS Clinical Commissioners, patient groups, the Care Quality Commission and the Department of Health, who all have key roles to play in making the GPFV a reality.

I’ve been pleased to see the energy of all concerned in response to developments so far. Everybody, not least NHS England, fully recognises the urgency and the need to work with, and through, local teams and CCGs. Many areas and organisations have already started mapping their own plans and setting up delivery teams for to work on the GPFV initiatives. We plan to make this a nationally available dashboard to help track progress of the 80 initiatives across all CCGs, giving visibility and accountability to the process.

In the coming weeks and months, we’ll continue to report back on progress across the key areas, and will work on building momentum with all stakeholders. Only with everybody’s support will we have a chance of navigating this challenge – which some have described as the mother of all turnarounds.

  • The General Practice Forward View: from vision to reality will be discussed at the Health and Care Innovation Expo 2016 on the Future NHS Stage at from 2-2.25pm on Wednesday 7 September.
  • Panelists will include:
    • Ian Biggs – Programme Director, Primary Care Workforce and Infrastructure Programme, NHS England;
    • Rosamond Roughton, Director of NHS Commissioning, NHS England;
    • Nigel Watson – Chief Executive, Wessex Local Medical Committees (LMCs)
Arvind Madan

Dr Arvind Madan was appointed as NHS England’s Director of Primary Care in October 2015 with view to him providing clinical leadership for the transformation of primary care provision.

Arvind is a practicing GP based at the Hurley Group, a large multi-site general practice and urgent care provider. He retains this regular clinical commitment looking after patients in East London.

Arvind has a strong track record of using new technology and redesigned ways of working across care boundaries to improve outcomes and deliver better value for money.

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  1. Dean James says:

    Dear Arvind
    I trust you are welland congratulations on the new appointment. We are re-launching our Charity on the 22nd Feb at HOC – it has a health and care mission plus related education and I would very much like to send you an invitation in case you might be able to attend. Could I kindly have your email so that I can send the formal invite?
    With Kind Regards

    Dean James
    CEO Future Care Capital

  2. Dr Diana Jelley Clinical Advisor GP Appraisal NHSE Cumbria and NE says:

    I am the clinical lead for GP Appraisal in the NE of England . I see one of the roles of GP appraisal as trying to support retention of established GPs within the profession. There is in theory provision for GPs [under GMS regulations
    to take a period of prolonged study leave [>10 weeks. The funding is provided by NHSE after educational approval by HEE
    However, I can’t find anyone within NHSE who knows whether such funding still exists , and if so, how it can be accessed
    If you can give me any guidance here I would be so grateful

  3. Kassander says:

    ”Calling Dr Arvind Madan. Calling Dr Arvind Madan.
    Customer Kassander is urgently awaiting your response to their THREE Part message.
    Pleas reply urgently.
    Thank you.”

    Kassander writes:
    23 August, 2016 at 5:12 pm
    Parts 1, 2 & 3 (Especially Part 3)

  4. Thomas Jones says:

    Are there not highly concerning conflicts of interest inherent in being a Director of the Hurley Group Ltd (plus other healthcare business interests – combined net worth of £4.2 million), whilst also being the Director for NHS Primary Care?

    • Kassander says:

      Come out Dr Arvind Madan, I know that you’re in there.
      Why don’t you respond to this point from Mr Jones, and those from me.
      Citizen, and its Online discussion site Gather, were designed to ”Hold the Board of NHSE to Account”.
      But since Anu Singh closed down Gather, and Citizen seems to be on ice, you seem to feel that you can completely ignore the concerns posted by the owners of our NHS = P&P = US.
      Come out Dr Arvind Madan, ‘WE’ all know that you’re in there.

  5. Kassander says:

    Just what is the point of having these comment boxes when after taking a considerable time to compose a positive and constructive critique my contribution is not posted?
    Added to which, even tho’ I’ve supplied my eMail address, no one has seen fit to tell me why my contribution has been ‘Mod-ed’ out of existence.
    How do you expect to ‘learn’ if you won’t listen to your ‘clients’ ?
    Or perhaps all you want is sycophantic praise?

    • NHS England says:

      Hi Kassander,

      We apologise for the delay in posting your comments.

      I can confirm that details of your comments have been passed on and any responses will be posted shortly.

      Kind regards
      NHS England

      • Kassander says:

        MANY thanks for that update, nameless person of NHS England.
        Good news that my comments have made it to this thread – even tho’ they’re date stamped days after they were posted.

      • Kassander says:

        I can confirm that details of your comments have been passed on and any responses will be posted shortly.
        Kind regards
        NHS England
        25 August, 2016 at 9:26 am
        Either NHSE’s definition of ”shortly” is very different from mine, or
        Their ”any response” in these circumstances is =”No response”.

        Why should ‘they’ respond anyway?
        ”They’ think the NHS is all THEIRS, not OURS, so why should they bother.
        Gosh, we’re expected to supply an email addy, ‘they’ don’t even give a contact name hiding behind the generic ”NHS England”.
        The ‘Mod’ function is probably outsourced to a sweatshop in some very low wage economy.

  6. Kassander says:

    Part 1 of 3

    Dr Madan guides us smoothly from his experience of
    ”… growing a group of GP practices across London, … .” to his present role of
    ”… providing clinical leadership for the transformation of primary care provision”
    A large undertaking for anyone.
    We learn of superb forward planning and implementation.
    ** the first £16million of the new £40million Practice Resilience Programme … ”’
    ** the first phase of the three-year £30million general practice development programme…”
    Our NHS is about people, and as Dr Madan noted :
    ”Only when everybody involved engaged with the plan did we make progress.”

  7. Kassander says:

    Our NHS is about people, and as Dr Madan noted :
    ”Only when everybody involved engaged with the plan did we make progress.”
    And we read ”colleagues from General Practitioners Committee, the Royal College of General Practitioners, NHS Clinical Commissioners, patient groups, the Care Quality Commission and the Department of Health, . all have key roles to play in making the GPFV a reality” And
    ”A GP Oversight Group has been set up to monitor the issues ​​”
    Hence these GP run SMEs, private contractors to our NHS, will be aided by additional financial and knowledge resources, provided by our NHS, to provide the service they are contracted to deliver.
    That is necessary because GPs are the front line of our NHS, dealing directly with the PATIENTS.
    So where do Patients figure in Dr Madan’s 900 word essay,?
    ​A​nd since he is also a deputy to Sir Bruce Keogh, in NHS England’s overall thinking?
    Yes there amongst all those full titled organizations :
    “patient groups”. No detail tho’

  8. Kassander says:

    Part 3
    Perhaps this will be one of the SECRET items on the HUSH HUSH Agenda for the ‘Workshops’ on the future of NHS England’s flagship NHS Citizen project scheduled for 12 Sept 2016, run under the auspices of Anu Singh, Director of Patient & Public Voice and Insight.
    ​Ms Singh is charged with:​
    ”ensuring that the voice of patients, service users, carers and the public is at the heart of the way NHS England works.” along with embedding
    ”patient and public voice, feedback and insight in the NHS commissioning system”
    Which might satisfy section​,​ 23 clause​ ​13Q of the Health & Social Care Act 2012​?​
    Ms Singh is the person who unilaterally closed the £2m + project down overnight a few months back, and via her staff is refusing point blank to publish the Aims and Objectives, or even the Agenda, for this Grand Gathering in but a few days time.
    I’m not as happy now as I was when I started reading this essay.​
    Still, I’m only a patient, so what’s it all got to do with me?

  9. Pierre Landell-Mills says:

    As a PPG Chair for a Devon GP practice, I am interested in understanding whether there is shared best practice in the managing of GP Practices. From our perspective, it seems that Practices operate very much in silos. This isolation suggests that there is far too little sharing of good management models for the various Practice activities (managing appointments, prescriptions, telephones, IT systems, record keeping, accounts, staffing profiles, training, management data systems and performance indicators, patient follow up, tracking of complex cases, patient communications, etc. etc.). And there is a desperate absence of transparency. Equally, it seems that there is no common set of expectations about what a GP Practice should cover beyond its core activities (e.g. public health information, life-style advice, youth health advice, support for carers. Am I missing something? Is there somewhere where best practice is laid out?

    • Kassander says:

      ”Am I missing something?”
      – – – –
      Possibly so = they’re SMEs, businesses. And therefore in a market – not the traditional co-operative of the NHS.
      If these SMEs are in a market, then they are ipso facto in competition with each other. So why should they share their ‘trade secrets’ with their competitors?
      I wonder what the possible solutions to that might be?

    • Dr Robert Varnam, Head of General Practice Development, NHS England says:

      Good point, Pierre. For a long time, there has been relatively limited sharing of good practice between GP practices. NHS England believes much more could be done to share the ideas and successes already ‘out there’. One part of this is the new 10 High Impact Actions to release time for care – a suite of examples of how practices can free up staff time. More information is at

      We are also working with the National Association of Patient Participation ( to support patients and practice staff themselves in connecting and sharing good ideas.

      It is also encouraging that the majority of GP practices are forming new collaborations such as federations, as these can be an excellent forum for developing and sharing new ways of serving patients better.

      • Kassander says:

        ​@​Dr Varnam, 31 Aug 11:33 am It is also encouraging that the majority of GP practices are forming new collaborations

        As with the Curate’s egg – encouraging in parts.
        Following the present, and recent, governmental leads, there is an over eager rush to Sell sell sell this country’s assets And as with so many of ‘our’ utilities the buyers are not UK based This extends into some other critical areas of UK’s major world assets as illustrated by the recent acquisition of ARM Holdings by a Japanese firm. Yes the originators of the Acorn Archimedes – and subsequently suppliers of vital parts to Smartphones and computers world wide.
        How long then before these rapidly developing Super Surgeries are bought up by eager investors? GPs who have for so long insisted on being free from and unshackled by, NHS find themselves as salaried servants of Big Pharma, or MediCover Inc?
        Then who will set their targets, and for what activities?

  10. Phil Yates says:

    This is good Arvind. I think it’s really valuable to get on the front foot with the comms as there are so many naysayers around.