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The Delivery Plan for the STP is vital

Blog by Dr Andy Mercer, Chair of the LMC's Western Sub-Committee

We have had the STP deliver their Strategy Plan for General Practice – the aim to moving forwards into 2021 with stability. The challenge to develop a General Practice that is fit for the future throws up a great deal of challenges the biggest I feel will be workforce. I think we have over the past 10 years been fortunate in Devon but the national crisis has now hit our practices.  Devon remains an attractive place to work but the increase in workload in General Practice makes recruitment and retention a challenge.

Instability in General Practice has not helped recruitment with GP trainees either choosing to move abroad on qualification – move out of area – or those who do remain in the locality often choose to work as on a sessional basis as there is less of a financial risk.

With the Success Regime intention to reduce spend in NEW Devon and the STP working across Devon to provide stability of the health care system in Devon the idea has been floated that work could move from Secondary Care into Primary Care.   This is seen as being a more cost-effective way to deliver care and possibly better for the patient with the resource following the patient. This raises alarm bells for me as so many practices are already struggling to provide their core and enhanced services and the threat of extra work is a step too far. For some practices, large amounts of money could be thrown to resource work in General Practice now, but without the workforce in some areas there is not the capacity to take on this work.

In the Western Locality we have seen the alarm bells escalating and crisis meetings have been held to stabilize a very fragile landscape. We have seen 4 GP practices close their doors and a further 2 practices have handed back their contracts (one being a super practice of 22,000 patients) this coupled with the failure by NHS England to procure a service for the 10,000 patients (currently being provided on an interim basis by Access Health) – fortunately Access are continuing to provide a service for these patients until there is re-procurement. This is likely to be in April 2018 with the patients from those practices who have handed back their contracts being included in the process allowing for the procurement of care for 33,000 patients! This is a great challenge for NHS England and the main worry is what is “Plan B” – having already failed to procure for 10,000 the ask of procuring a service for 33,000 patients may be attractive to national providers but the worry is still workforce. Some of the local practices are seeing numbers of up to 30 patients a day join as new patients – these are often patients with complex medical needs.   Practices have requested to close or cap their lists to prevent destabilization of the whole system.

Looking at the workforce for the future – we have to ask “Where is the next generation of GPs coming from?” In North Devon, even with the prospect of a 'Golden Handshake' training places are not filled. There has also been talk of looking at GPs who have chosen to retired being tempted back into the workforce – is this a realistic option. Partners and Senior GPs have often left as the workload has become overwhelming and changes to the Pension Scheme have made the option of staying less attractive. We also have very experienced GPs waiting to retire but feel they cannot as there are no candidates applying to take on substantive roles and their retirement would increase the pressures on those left or even result in closure of the practice.

We have seen the formation of four locality collaborative boards - GPs working together to try and deliver effective change in general practice for the benefit of the health care system and enable stability. These remain unfunded boards (despite the assurances made to date) and GPs are meeting in their spare time to develop a sustainable system. It is hoped that this will be soon funded and allow development of a sustainable general practice to be actioned as a priority and not in our spare time (which is reducing as workload increases).

Whilst I eagerly await the Delivery Plan to be published showing how the commissioners plan to put into practice the GP Strategy,  for some practices it is a little too late.