This briefing paper from the House of Commons Library covers many aspects of GP services. This update covers recent changes, including those relating to funding, commissioning and named GPs for the over 75s. Many other considerations are summarised, with the latest statistics on demand, funding pressures, the GP workforce, expenditure and earnings data, access to GP services, patient choice of practice and boundary changes.
Extended opening hours, out-of-hours services, waiting times for appointments and the 2015 Conservative Government commitment to provide 7 day access to GPs are discussed. Information is supplied on general practice performance, plus links to further information. Section headings comprise:
- Commissioning and funding of GP services.
- Recent changes – funding, commissioning and named GPs.
- Demand, workforce and funding pressures.
- GP workforce, expenditure and earnings data.
- Access to GP services: extended hours, out-of-hours, waiting times and 7 day working.
- Choice of practice and boundary changes.
- General practice performance data.
- Further information.
Powell, T. [and] Blow, E. (2015). General Practice in England. London: House of Commons Library, June 22nd 2015. Commons Briefing Paper CBP-07194.
Seven-day working has strong backing from the Department of Health but faces continuing BMA opposition:
Triggle, N. (2015). Doctors: Hunt willing to impose seven-day working. London: BBC Health News, July 16th 2015.
This relates to:
Full Text Link (Transcript of speech).
Making healthcare more human-centred and not system-centred. London: Department of Health and Rt Hon Jeremy Hunt MP, July 16th 2015.
Department of Health’s Factsheet Regarding 7-day NHS Services
The following factsheet explains why and how the government intends to make NHS services safer.
7-day NHS services: a factsheet. London: Department of Health, July 24th 2015.
September 2015: Update on the Seven Day Working Debate
The RCGP commented:
Triggle, N. (2015). NHS weekend: 7-day GP opening ‘unachievable’. London: BBC Health News, September 5th 2015.
There is a further BBC News piece:
NHS weekend: 7-day services explained. London: BBC Health News, September 5th 2015.
More than just a war of words?
Pym, H. (2015). The war of words over 7-day GP services. London: BBC Health News, September 5th 2015.
Workload Versus Safety?
The RCGP has asserted that rising pressure from more consultations, more complex cases and increased bureaucracy is resulting in fatigue and burnout, thereby putting patient safety at risk.
Triggle, N. (2015). GP workloads ‘put patients at risk’. London: BBC Health News, July 29th 2015.
This relates to:
Patient safety implications of general practice workload. London: Royal College of General Practitioners (RCGP), July 28th 2015.
Quality first: managing workload to deliver safe patient care. London: British Medical Association (BMA), January 2015.
Original Proposals on the New Deal for General Practice
The New Deal for GPs hit the headlines in May – June 2015, but a document issued jointly between the BMJ, RCGP and NHS England, appeared first in January 2015. Recommendations included:
- Promoting general practice.
- Improving the breadth of training.
- Training Hubs.
- Targeted support.
- Retaining Staff.
- Investment in retainer schemes.
- Improving the training capacity in general practice.
- Incentives for remaining in practice.
- New ways of working.
- Return to practice.
- Easy return to practice.
- Targeted investment on returners to practice.
Snow-Miller, R. (2015). Building the workforce: the New Deal for General Practice. Version no.1. London: NHS England, BMJ [and] RCGP, January 26th 2015. Official Publications Gateway Number: 02918.
Demand for Weekend Services?
According to analysis of data from the 2014 General Practice Patient Survey, which involved over 800,000 patients across England, 81% of people are happy with their GP surgery’s opening hours, and Sunday appointments are not in demand.
Sunday GP appointments ‘not in demand’, research says. London: BBC Health News, November 6th 2015.
Real-Term Growth in Funding Settlements
“Spending on GPs and primary medical care services will grow in real terms at a higher rate than for other health services, with an extra 4%-5.4% cash funding every year for five years”.
NHS leaders set out new long-term approach for sustainability and transformation. [Online]: NHS England, December 22nd 2015.
NHS England allocates £560 billion of NHS funding to deliver NHS Five Year Forward View. [Online]: NHS England, December 17th 2015.
The BMA’s GP leader Dr Chaand Nagpaul has reported that doctors are increasingly rushing patients, potentially at the cost of failing patients interests and providing unsafe care:
Triggle, N. (2016). GP pressures: Care potentially unsafe – doctors’ leader. London: BBC Health News, February 3rd 2016.
New GP Contract
The new GP contract involves an investment of £220 million for 2016/17; part of which provides a pay uplift of 1% for GPs.
NHS England, Government and BMA agree new GP contract for 2016/17. London: NHS England, February 19th 2016.
“That will require radical new options, including further support for GP recruitment and return to practice, funding for additional primary care staff, new options for practice premises, a reduction in paper-based red tape, alternative approaches to indemnity cover, and redesigned out of hours, 111 and extended hours arrangements, to name just a few – all underpinned by much greater team working across individual practices”. Simon Stevens: Chief Executive of NHS England.
NHS England’s Five Year GP Strategy
The five-year plan to help GP surgeries will involve an additional £2.4 billion per year invested into GP services by 2020; this represents a rise of 14% after inflation.
Triggle, N. (2016). NHS in £2.4bn funding boost for GP services in England. London: BBC Health News, April 21st 2016.
NHS England backs general practice with a multi-billion transformation plan. London: NHS England, April 21st 2016.
General Practice Forward View. London: NHS England, April 2016.
This relates to:
General Practice Forward View [April 2016]. London: NHS England, April 20th 2016. Gateway Publication Reference No. 05116.
Helen Stokes-Lampard, Chair of the Royal College of GP’s Council, has warned that general practice is “skating on thin ice” due to over-stretch, with patient waits to see a GP of up to one month, despite NHS England’s commitment to an extra £2.4 billion (in real terms) of investment by 2020.
Senior GP Helen Stokes-Lampard voices fears for services. London: BBC Health News, December 29th 2016.
Smoke and mirrors allegation:
Triggle, N. (2017). BMA chief: NHS is ‘running on fumes’. London: BBC Health News, June 26th 2017.
Variations in Use Of Locums In Deprived Versus Affluent NHS Areas
Patients in the most deprived areas of England are more likely to encounter an over-reliance on locum GPs. The British Medical Association has asserted that the shortage of GPs generally means that people in these deprived areas may face poorer levels of care as a result. NHS England plans to recruit 5,000 more doctors into general practice by 2020 (see the General Practice Forward View above).
Locum GP rates ‘linked to deprivation’, British Medical Association warns. London: BBC Health News, June 13th 2016.
Patient List Cleansing
Around three million “ghost” patients registered with GP practices in England will be removed from GP’s patient lists by the company Capita:
Triggle, N. (2016). NHS targets ‘ghost’ patients who don’t go to the GP. London: BBC Health News, July 20th 2016.
Hunt for three million ‘ghost’ patients. London: BBC Health News, September 27th 2016.
This relates to:
General and Personal Medical Services, England September 2015 – March 2016: Provisional Experimental statistics. London: NHS Digital, September 27th 2016.
Ghost patients still a problem in 2019:
Triggle, N. (2019). GP ‘ghost patients’ to be investigated by NHS fraud squad. London: BBC Health News, June 12th 2019.
On Failing GP Surgeries
Leaks rather than official policy?
Pym, H. (2016). Let struggling GP surgeries fail, says NHS England letter. London: BBC Health News, October 12th 2016.
Self-Care Could Prevent Millions of Unnecessary GP Visits (LGA)
The Local Government Association has advised use of pharmacies or NHS websites, instead of attending GPs, for minor conditions and illnesses.
Don’t go to GP with runny nose, councils urge the sick. [Earlier title = Simple self-care measures could end millions of unnecessary GP visits every year, says the LGA]. London: BBC Health News, November 5th 2016.
A Problem of GP Capacity Rather Than Opening Times?
The debate over extending GP surgeries opening hours continues, as the government has asserted that surgeries should aim to be open between 08:00 and 20:00, seven days a week, or lose some of their “additional” funding (unless they can prove there is genuinely no demand from patients).
GPs urged to commit to seven-day service or lose funding. London: BBC Health News, January 14th 2017.
Referral Management Centres: Obstacles Between GP Referrals and Patient Treatment?
The British Medical Association (BMA) has warned that referral management centres can introduce inefficiencies and delays in the patient referral process. Others disagree:
Clahane, P. (2016). Referral centres cause ‘dangerous’ NHS delays, BMA warns. London: BBC Health News / BBC One Inside Out, January 16th 2017.
Patient Access / Care Payment Proposals?
Proposed contravention of strict safeguards and rules which stop GPs charging their own patients for access to care.
Mundasad, S. (2017). Patient payment proposals for extra GP care. London: BBC Health News, January 25th 2017.
Next Steps on the NHS General Practice Forward View
Details for future reforms for the General Practice Forward View (see above) are supplied, listing achievements to date, including co-funding for 491 clinical pharmacists working across 658 practices. Numbers of clinical pharmacists in general practice will increase to over 900 by March 2018, and over 1300 by March 2019.
Next steps on the NHS Five Year Forward View: NHS England takes next steps towards the future of primary care. [Online]: NHS England, March 31st 2017.
Foreign GPs Recruitment: Stopgap Measures?
International recruitment of GPs is part of the £2.4 billion to be invested in GP services by 2020.
Triggle, N. (2017). NHS launches £100m drive to recruit foreign GPs. London: BBC Health News, August 31st 2017.
Clinical Pharmacists in General Practice
Surgery-based clinical pharmacists at over 700 practices in England will be available to assist with routine medication and treatment.
“ …over £100m of investment [will] support an extra 1,500 clinical pharmacists to work in general practice by 2020/21. This is in addition to over 490 clinical pharmacists already working across approximately 650 GP practices as part of a pilot, launched in July 2015”.
Up to six million people set to benefit from more clinical pharmacists in GP surgeries. [Online]: NHS England, April 12th 2017.
This relates to:
Clinical pharmacists in general practice – supported sites. [Online]: NHS England, 2017.
GP at Hand Service (Online GP Consultations)
A 24-hour pilot service has been launched for NHS patients in London, offering GP consultations via video link using smartphones:
NHS offers smartphone GP appointments. London: BBC Health News, November 6th 2017.
Further analysis of the RCGP’s assertion of a twin-track general practice risk:
Pym, H. (2017). Online GP consultation: Opportunity or threat? London: BBC Health News, November 6th 2017.
Shared Appointments: Suitable for Certain Long-Term Conditions?
Time, costs and manpower resource can be saved, perhaps with some benefits to patients too:
Shared GP appointments trialled – and patients ‘like’ them. London: BBC Health News, October 6th 2018.
Another Crisis: GPs Leaving Direct Patient Care
The British Medical Association (BMA) asserts that GPs are leaving their jobs at an increasing rate due to feeling “undervalued” and subject to unlimited demands / pressures.
‘Undervalued’ GPs fuelling a ‘crisis’. London: BBC Health News, February 3rd 2018.
This relates to:
Sansom, A. Terry, R. [and] Fletcher, E. [et al] (2018). Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England. BMJ Open. January 10th 2018; 8(1): e019849.
We All Make Mistakes
Something to do with anonymous comments on an online medical forum.
NHS England’s most senior GP resigns over anonymous online posts. London: BBC Health News, August 5th 2018.
This relates to:
Statement from Dr Arvind Madan. [Online]: NHS England, August 5th 2018.
Mentions vertical integration at the Royal Wolverhampton NHS Trust:
Baird, B. Reeve, H. Ross, S. [et al] (2018). Innovative models of general practice. London: King’s Fund, June 2018.
Working at Scale
National policy encourages general practices to serve populations of >30 000 people (termed “working at scale”) by collaborating with other practices or hospitals. Approximately 5% of practices are working at scale; whether as large practices, superpartnerships, or multi-site organisations. Perhaps 50% of practices are working in looser collaboration, focusing on services beyond core general practice such as offering primary care at evenings and weekends.
Forbes, LJ. Forbes, H. [and] Sutton, M. [et al] (2019). How widespread is working at scale in English general practice? An observational study. British Journal of General Practice. September 9th 2019. [Epub ahead of print].