This week Ben Gowland turns his attention to our quarterly review of all that is new in general practice. And what a three months it’s been…

The planning guidance is out there

First off, the release of the NHS planning guidance. You can read our take on what this means for general practice, but essentially its distillation of the GP Forward View (GPFV) was an extra £3 a head for practices from CCGs in either 2017/18 or 2018/19 (or split across the two), and extra money for access from 2018 onwards (£3.34 per head in 2018/19 rising to £6 per head in 2019/20). CCGs have to produce a plan by 23^rd December as to how they are going to implement (and fund!) the GPFV locally. We produced some thoughts for CCGs to ponder when crafting these plans, urging them to nurture and build on the seeds of local momentum rather than impose top down change.

Is operating at scale still an answer?

Many of these plans will inevitably include hopes of general practice operating at scale in future. We have seen some notable successes – City and Hackney GP Confederation put on a conference in November to share their achievements, and the country’s largest “super-practice”, Our Health Partnership in Birmingham, shared their progress over the last 6 months. However, all is not rosy in the at-scale garden. Horizon Health Choices Ltd in Bedfordshire, a 54 practice federation, went into liquidation proving yet again that scale itself is not the answer; but how you do it is. Our quick guide to introducing change in general practice will help anyone embarking on that particular journey.

Running with the GPFV

What of the GPFV? Well the latest allocations for the Estates and Technology Transformation Fund were released, and were generally less than expected and given a national prioritisation that differed from (and superseded) those made locally. We took time out to consider the trends in the world of primary care estates, where many GPs are looking for an exit route which the new models of care might just provide!

Interestingly, momentum in the GPFV implementation seems to have mainly come from internal productivity improvements within practices. CCGs received their share of funds for training medical assistants and GP receptionists, and (somewhat surprisingly?) it is having a huge impact. The 10 high impact changes, initially dismissed as a gimmick by most on first reading of the GPFV, are rapidly becoming one of the most useful parts of the document. Maybe even more surprisingly physician associates are starting to show the impact they can have on GP practices.

Collaborating with patients

Social prescribing, meanwhile, is gaining increasing credibility as a way of blurring the boundaries between primary health care and social care. Its most practical (and, in our view, finest) application is the development of leg clubs – using the need for medical treatment to create a sense of community and to tackle the social isolation leg ulcers can bring. New life has even been breathed into the often-dreaded patient participation group (PPG), with the development of virtual PPGs enabling much wider local participation in the practice than the traditional meeting format.

Sustaining and transforming…

The STP plans were also (finally!) published. The main complaint pre-publication was the lack of GP provider involvement on the STP boards. We looked at how general practice should be represented, and argue it is a choice GP practices should make for themselves as opposed to one imposed by the system. Given most of the STPs are reliant on a “transformation” of out of hospital care, lack of early involvement of general practice may be something areas come to rue later on.

New models of care

GP enthusiasm for MCPs has (at best) remained neutral over the last few months. Dudley CCG have published the first specification, but the promised draft MCP contract due in September has been put back until January, with growing murmurings of unrest from some of the practices involved. The second wave of primary care home sites was announced. Despite having no money attached, it was heavily subscribed. Even Simon Stevens acknowledged this is where the enthusiasm in general practice lies.

In fact one of the original primary care home rapid test sites, Beacon Medical Group, houses the newly acclaimed GP of the Year, Dr Jonathan Cope. Richly deserved. If you don’t know what he has been up to you can listen to him explain both how they transformed the way the practice works by introducing new roles , and how the practice has become a system integrator by building an impressive range of partnerships.

The legacy of CCGs

Simon Stevens hasn’t just spoken of the value of primary care homes. At the NAPC conference, as well as saying that QOF “was now nearing the end of its useful life”, he exhorted GPs to make general practice the CCG’s priority. If the legacy of an underfunded general practice remains after the period when GPs have been in charge of the money, and after an extra £2.4bn has been promised nationally, the implication was that it will be on GPs’ own hands.

What do you buy the GP who has everything?

But the highlight of the last few months has undoubtedly been the publication of our first book, “The Future of General Practice”. Described by one reviewer as, “probably the best summary of the options open to general practice that I have seen. It is… packed with examples, tips, lessons and practical guidance… I heartily recommend it to everyone interested in the options for GP development”. Christmas present – sorted.

Have a great Christmas!