Overview of General Practice in England (House of Commons Library / BBC News / BMA / NAO / BMJ / Nuffield Trust)

Summary

This House of Commons Library briefing note supplies information on NHS primary medical services provided by GPs in England. It has been updated to cover elements of the new GP contract; including the introduction of named GPs for people aged over 75 and increased choice of GP practice. Extended opening hours, out-of-hours services, waiting times for appointments, commissioning arrangements, funding arrangements, different contracting routes for core and enhanced services, financial pressures, increasing demand for GP practices, GP numbers, expenditure and earnings are also covered.

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Reference

Powell, T. (2013). General Practice in England. London: House of Commons Library, June 6th 2014. Standard Note: SN06906.

GP Access

According to the British Medical Association, longer waits to see GPs in the UK are becoming the norm:

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Reference

Triggle, N. (2014). Patients ‘facing longer GP waits’, warns BMA. London: BBC Health News, June 25th 2014.

and:

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Reference

Triggle, N. (2014). GP access: A story that is here to stay. London: BBC Health News, June 25th 2014.

GP Training and Recruitment

Hundreds of GP practices could be at risk of closure according to the RCGP because of the ageing workforce and rising demand resulting in a recruitment crisis and GP training shortfall. The Department of Health says the number of GP training places is in fact rising, from just over 2,700 last year to 3,250 a year by 2016.

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Reference

Triggle, N. (2014). Over 500 GP practices ‘risk closure over ageing workforce’. London: BBC Health News, October 2nd 2014.

Promotional Recruitment Video

The RCGP has produced a national recruitment video, encouraging medical students to choose general practice as a career:

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Reference

Dreaper, J. (2015). GP recruitment drive film ‘tackles outdated stereotypes’. London: BBC Health News, August 20th 2015.

GP Patient Survey 2013-14 (NHS England)

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Reference

Triggle, N. (2014). Seeing a GP ‘getting more difficult’. London: BBC Health News, July 3rd 2014.

Results from the national GP Patient Survey 2013-14 indicate 85.7% of patients still rate overall experience of their GP surgery as good. Satisfaction with out-of-hours care remains lower (66.2% of patients rating their overall experience good).

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Reference

GP Patient Survey 2013-14. London: NHS England, July 3rd 2014.

National Audit Office Report on Out-of-Hours GP Services

The total number of cases handled by GP out-of-hours services has fallen by 2.8 million since 2008, partly due to the introduction of NHS 111. A National Audit Office survey of 878 people in England found one in five is unaware of the new 111 urgent phone service.

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Reference

Triggle, N. (2014). One in four ‘unaware of GP out-of-hours care’. London: BBC Health News, July 11th 2014.

This relates to:

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Reference

Department of Health and NHS England. Out-of-hours GP services in England. HC 439. Session 2014-15. London: National Audit Office, July 11th 2014.

Possibly also of interest:

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Reference

Tiley, CG. (2014). Patients are often unaware of how to access medical help out of hours. The British Journal of General Practice: the Journal of the Royal College of General Practitioners. August 1st 2014; 64(625): 389.

CCGs are responsible for monitoring the quality of out-of-hours services, including those provided by GP practices which provide them under their GP contract.

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Reference

Monitoring Arrangements For OOH Primary Medical Services Where Practices Have Not ‘Opted Out’. [Letter]. London: NHS England, August 11th 2014. Publications Gateway Reference No. 02088.

According to the Care Quality Commission (CQC), GP out-of-hours services in England are improving, with some remaining weaknesses in certain areas of care:

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Reference

Triggle, N. (2014). GP out-of-hours care ‘getting better’. London: BBC Health News, October 3rd 2014.

CQC Inspection Regime Drives-Up Standards (Chief Inspector of General Practice)

The Care Quality Commission has been piloting the inspection of GP practices, between April and June 2014. The 348 pilot inspections so far confirm that most practices provide high quality care, with a minority providing very poor care.

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Reference

“New inspection regime will drive up standards and promote improvement”, says Chief Inspector of General Practice. London: Care Quality Commission (CQC), September 30th 2014.

The RCGP has responded to comments that up to 200 GP practices across England may face “threats” of closure. Dr Maureen Baker, Chair of the RCGP, agrees there is no excuse for poor practice, but points to lack of resources as the main threat to safe and effective care.

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Reference

RCGP response to Professor Steve Field’s warnings of up to 200 practice closures. London: Royal College of General Practitioners (RCGP), September 30th 2014.

GPs have attacked the new CQC inspection regime as overly bureaucratic and nit-picking:

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Reference

Triggle, N. (2015). Suspend inspection regime, GPs urge. London: BBC Health News, June 23rd 2015.

Telephone Consultations

GP consultations over the phone may not reduce workload pressure on busy surgeries, research indicates:

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Reference

Gallagher, J. (2014). Phone consultations ‘do not cut GP surgery pressures’. London: BBC Health News, August 4th 2014.

CQC’s National Failure Regime

The Care Quality Commission has confirmed that the special measures regime used for hospitals will be extended to GPs. Under this national failure regime for general practices, those practices rated “inadequate” will be allowed six months to one year to resolve problems.

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Reference

Triggle, N. (2014). Failing GP practices face closure. London: BBC Health News, August 14th 2014.

This relates to:

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Reference

Care Quality Commission announces special measures to target failing GP practices. London [Online]: Care Quality Commission, August 13th 2014.

Possibly of interest:

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Reference

Triggle, N. (2014). Failing GPs: A Pandora’s Box? London: BBC Health News, August 14th 2014.

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Reference

Special measures to help GP practices improve. London [Online]: Care Quality Commission (CQC), January 15th 2015.

The Care Quality Commission found significant areas of concern at surgeries in Liverpool, Reading and Greater Manchester.

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Reference

Gallagher, J. (2015). GP practices in special measures. London: BBC Health News, January 22nd 2015.

The positive flip-side of this review:

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Reference

60 GP practices found to be Good or Outstanding by CQC inspectors. London [Online]: Care Quality Commission (CQC), January 22nd 2015.

Passing insights into a salutary countervailing viewpoint:

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Reference

Patterson, J. (2015). A fit and proper ending. London [Online]: NHSNetworks, January 23rd 2015.

Announcements at the Conservative Conference (Birmingham, September 2014)

More money is being provided for work towards the availability of seven-day GP access throughout England by 2020. Seven days, 12-hours a day, good access to GPs is expected to improve community-based healthcare and help reduce avoidable hospital admissions.

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Reference

Wheeler, B. (2014). David Cameron promises seven-day GP access by 2020. London: BBC Health / Politics News, September 30th 2014.

Possibly of interest:

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Reference

Triggle, N. (2014). The battle over GP opening. London: BBC Health News, September 30th 2014.

The Conservatives also pledged to protect funding for the NHS in England from cuts for five years:

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Reference

Cameron vow to ring-fence NHS spending for another five years. London: BBC Health / Politics News, October 1st 2014.

A BBC News analysis:

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Reference

Triggle, N. (2014). NHS budget: What we aren’t being told. London: BBC Health News, October 1st 2014.

Numbers of Patients Registered at GP Practices (HSCIC)

The Health and Social Care Information Centre (HSCIC) has published the latest quarterly data (to September 30th 2014) from the GP payments system. Data at GP Practice level shows single year of age bands and 5-year age bands (up to age 95+), both by gender and aggregated. Data at the levels of Clinical Commissioning Groups, NHS England Area Teams and NHS England Regions are also in 5-year age bands up to age 95+, both by gender and aggregated.

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Reference

Numbers of Patients Registered at a GP Practice – Oct 2014. London [Online]: Health and Social Care Information Centre (HSCIC), October 16th 2014.

Questions of Morale (and Burn-Out)

The British Medical Association points out that GPs tend to have a lower level of morale and a poorer work-life balance than their peers elsewhere in the health service.

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Reference

Triggle, N. (2014). Is there really a crisis among GPs? London: BBC Health News, November 4th 2014.

CQC Inspections Find Problems in Accessing GP Appointments

The latest Care Quality Commission (CQC) inspection of 336 GP practices found that patients in one sixth of surgeries experience problems booking appointments.

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Reference

Some patients ‘struggling to book with GP’, watchdog says. London: BBC Health News, November 16th 2014.

GP Workload: Future of General Practice Survey (2015) BMA Poll

A BMA poll of over 15,500 UK GPs found 90% believed a heavy workload had a negative impact on the quality of care. Many GP practices reported an inability to provide seven day opening and the need for collaborative working in the form of shared sites offering extended hours to patients. Better funding and more time with patients are needed to improve services according to this survey:

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Reference

Triggle, N. (2015). GP workload harming care, BMA poll suggests. London: BBC Health News, April 9th 2015.

This relates to:

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Reference

British Medical Association (2015). National survey of GPs: the future of General Practice 2015. Extract of Findings; December – February 2015. A report by ICM on behalf of the BMA. London: British Medical Association (BMA) General Practitioners Committee, April 2nd 2015.

There is also an Executive (Infographic) Summary.

GP Out-of-Hours Services Provided by Commercial Companies

Research, by Exeter Medical School, indicates that GP out-of-hours services provided by commercial companies (for example, to cover weekends and between 18:30 to 08:00 on weekdays) perform slightly worse – in terms of poorer experience of care (timeliness, confidence and trust in clinician, and overall experience) – than NHS or not-for-profit equivalents.

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Reference

Private GP out-of-hours care ‘worse’. London: BBC Health News, May 1st 2015.

This relates to:

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Reference

Warren, FC. Abel, G. [and] Lyratzopoulos, G. [et al] (2015). Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross-sectional postal questionnaire survey. British Medical Journal (BMJ). April 29th 2015; 350: h2040.

May 2015: Prime Minister’s Plans for a Seven-Day NHS

Plans for 7-day NHS services, and funding to increase by £8 billion per year.

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Reference

PM on plans for a seven-day NHS. London: Department of Health, May 18th 2015.

BMA’s “Surreal Obsession” Attack on Hunt’s 5,000 More GPs by 2020 and PM’s Surgeries to Open Seven Days Per Week Ambition

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Reference

Pym, H. (2015). ‘War of words’ likely over seven-day GP opening. London: BBC Health News, May 21st 2015.

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Reference

Gallagher, J. (2015). Doctors hit out at plans for seven-day GP surgeries. London: BBC Health News, May 21st 2015.

June 2015 Update

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Reference

Triggle, N. (2015). Why are GPs so angry? London: BBC Health News, June 17th 2015.

A Nuffield Trust’s “Transforming general practice… levers for change” report reviews the evidence on options for change, and presents recommendations for policy makers and regulators. It is asserted that traditional financial “micro” incentives, such as the quality and outcomes framework (QOF), may be over-used and ineffective in big-picture reform of general practice.

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Reference

Rosen, R. (2015). Transforming general practice: what are the levers for change? Policy Briefing. London: Nuffield Trust, June 16th 2015.

New Deal Proposed for General Practice

Jeremy Hunt, Secretary of State for Health has proposed first steps in a new deal for GPs, involving a trade-off offering increased investment for primary care in return for seven-day working in general practice.

Full Text Link (Transcript of speech at Nelson Medical Practice [London]).

Reference

New deal for general practice. London: Department of Health and Rt Hon Jeremy Hunt MP, June 19th 2015.

Comment and brief analysis from BBC News:

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Reference

Triggle, N. (2015). GPs offered ‘new deal’ if they agree seven-day opening. London: BBC Health News, June 19th 2015.

See also:

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Reference

Triggle, N. (2015). Why bother with seven-day GP opening? London: BBC Health News, June 19th 2015.

Note: An updated House of Commons Library Overview of General Practice appeared in mid-2015; accordingly this discussion will become the latest general “common place” location for the collection of GP-related news and developments from July 2015 onwards (until further notice).

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Dementia and Elderly Care News. Wolverhampton Medical Institute: WMI. (jh)
This entry was posted in BBC News, Commissioning, Community Care, Department of Health, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), In the News, Integrated Care, Management of Condition, National, National Audit Office, NHS, NHS England, Person-Centred Care, Quick Insights, Standards, Statistics, UK, Universal Interest and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

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