There has been something of a frenzy of activity over the summer, following the publication of the General Practice Forward View (GPFV) earlier in the year, and if you have been away it is easy to have missed what has been going on!

Arguably the biggest development was the publication of the new MCP (multispecialty community provider) contract framework.  This, potentially, represents the end of the independent contractor model for General Practice.  Our 15-minute guide tells you all you need to know, but essentially it is about creating new organisations that general practice are part of, as opposed to new general practice organisations.

They are entirely voluntary, which begs the question why would GP practices choose to join.  I spoke to Tracey Vell, the LMC GP lead for the implementation of the new contract in Manchester, and she told me practices are falling over themselves to join for three main reasons: a way out of the current pressures; because they will be bought out of their building; and because the new organisation will pick up indemnity.

The publication of the MCP contract guidance, which outlines the new contract length will be 10-15 years, coincided with a resurgence in APMS contracts.  North Derbyshire, Blackpool and elsewhere are now introducing these not as a tool for competition to “market test” general practice, but as an enabler of integration between GP practices and other providers.

For some, the MCP is seen as the lesser of two evils because the alternative new model of care, the Primary and Acute Care System (PACS), is regarded as the takeover of general practice by the local hospital.  However, Dr Berge Balian, the GP lead at Yeovil Hospital for the local PACS, contends instead it provides an opportunity for general practice to be paid for work transferred from the hospital.  As a result, practices in Yeovil are choosing to give up their contracts to join Symphony Healthcare Services, an organisation wholly owned by the hospital.

The big question following the publication of the GPFV is where is the money?  This was brought into even sharper focus following the revelation much of the GPFV money would be allocated via the STP areas (cue the introduction of RCGP ambassadors to each STP area).   I spoke to Maureen Baker about the GPFV money to get her take on where it is and what it will really amount to, and for those still in the dark we have produced our own guide on how to find it.

“Primary care access centres” were trailed in the GPFV as a mechanism for extending GP access.  The BMA has since produced its own document, “Safe Working in General Practice”, renaming them “locality hubs” and describing them as overflow facilities for “full” general practice.  Either way, they amount to the same thing and require practices to work together to create them.  Handily, the Nuffield Trust published “Is Bigger Better? Lessons for Large Scale General Practice”.  They found evidence of improvements in quality lacking, but author Rebecca Rosen did conclude bigger is indeed better as a mechanism for enabling general practices to cope with the current challenges.  For those wanting to up their scale, Jenny Stone gave us a guide to practice mergers, and Nigel Grinstead shared the lessons he has learnt supporting federations and super practices to develop.

Meanwhile, the challenges of recruitment in general practice have not gone away.  We looked at the transformational impact paramedic practitioners have had on one practice, and asked the question more broadly as to whether social workers could form part of the practice team.  However, the action that can make the biggest impact locally in our view is the introduction of a local locum GP chambers.  Chair of NASGP Richard Fieldhouse explains what they are, and we heard from an ex-GP partner, a newly qualified GP, and a GP seeking a portfolio career about the impact chambers had on them.  We explained why you need one, how a CCG can support their development locally  , how a CCG can make the most of one they have, and we tackled the difficult questions and dispelled some of the myths about locums.

Finally, the Kings Fund produced a new report, “Clinical Commissioning: GPs in Charge”.  Author Ruth Robertson revealed they had discovered a frequently fragile relationship between CCGs and local practices, and predicted fewer, larger CCGs in future.  Less clear was whether GP leaders would remain in these bigger CCGs or take up residence in the new models of care.

You are now up to date!  If you want to keep it that way, become an Ockham subscriber and we will send you (free) weekly updates so you don’t a miss a thing.