“The coming year will be crucial for general practice…”

February 22, 2013 | Filed under ,

It has been a fascinating week in the NHS, with ongoing media coverage over the Francis Report and renewed calls for the resignation of the head of the NHS Commissioning Board, David Nicholson from the daily papers; but for now he survives.

Set against this is the extremely optimistic comment from health minister Lord Howe, stating that he thinks the NHS could face one of “its best years yet” with the onset of CCGs and GPs involvement in commissioning: www.gponline.com.

His exact words were: “Many argue this will be the most challenging year the NHS has ever faced. But with GPs at the heart of shaping local health services, I believe it will end up being one of its best.”

Optimism is healthy, but many GPs are left wondering whether politicians and patients now consider them superhuman, and possessing extraordinary powers, if they are able to deliver the NHS from financial meltdown, while at the same time potentially having to do masses of new work, with the probable imposition of a new GP contract for which the consultation ends on the 26/02/2013.

The BMA has published its 30 page response to the consultation, which in summary says they think what is being required is ‘unfair’ and ‘unfeasible’. It is well written, evidenced, and includes the result of a survey of 24,000 GPs in England, of which 7,000 responded, and warned of reduced services and likely increased retirements from the profession.

The Department of Health has notably responded almost before having time to have read the submission, rather ‘poo-pooing’ it all, and saying it will be good for patients. That tends to suggest they have made their minds up already, so my view is don’t expect too many changes unless there is a dawning of reality over ministers and the DH!

The coming year will be crucial for general practice as a profession I feel – how GPs respond and balance the needs of patients against the needs of politicians, as expressed through the contract and the needs of their personal incomes, will be critical to their perceived trust by the public.

That is another news item this week – Poll reveals doctors are most trusted profession. But it won’t hit the front pages easily as it’s a dog bites man story – doctors are the most trusted profession, with 89% of the public trusting them to tell the truth compared with politicians at the bottom of the poll, with only 23% of the public trusting them to tell the truth.

I feel the thrust and counter thrust between the BMA and the wider GP body and the Government will be a running theme all year. Laurence Buckman of the BMA has said the “Government holds all the cards”, but in the public perception index having 66% more public trust must be a joker in the pack Laurence!

The Francis Report is all about the need for openness, honesty and public trust – it will be intriguing to see how the government responds to this report and how many of the 290 recommendations are actually addressed through policy and legislation.

That is what really matters for the NHS, and we expect the response in March.

One emerging issue the Alliance would value your feedback on, is the emerging gap in Primary Care Support Services, as responsibility for commissioning GP, dentistry, pharmacy and optometry services passes from PCTs to the NHSCB.

It appears that certain key functions PCTs have provided are in danger of being “lost in transition” and not being picked up at all.

In one letter I have seen to an LMC Chair from the NHSCB I quote: “The NHSCB as a direct commissioner of Primary Care does not have a Primary Care Provider Support Function nor do the Clinical Commissioning Groups”

“We are therefore in a position that there is no identified receiver body or funding flow for the following functions’.

Functions named include:

  • Named Doctor for child protection
  • PALS function for primary care
  • Alerts (eg, Public Health, child protection, missing scripts)
  • Safeguarding adults advice and training

Clearly these need to be rapidly addressed, so let me know if you have similar issues in your area. What is clear is the NHSCB will be contracting for GP services but not supporting them.

So, an imposed contract, the CCG commissioning agenda, review of PMS and GMS baseline funding (but with no modeling to assess the impact) and a loss of primary care support functions – will this be the best year ever for GPs in the NHS?

I am left wondering whether there is any political will to see General Practice survive, or is the plan to break it up and sell it off?

We could and should ask the politicians that question but the problem is …only 23% would believe the answer!


If you would like to  provide feedback on the blog, please email: feedback@nhsalliance.org.

The comments are those of Dr Jenner in his NHS Alliance, GMS lead role, and not those of any other organisations he works for or in.