Posts in Community

Most partners plan to cut costs by reducing use of locum GPs

10 October 17

This post was originally posted on GP Online by Neil Roberts on the 27 September 2017


Over 60% of GP partners plan to cut their practice's use of locum GPs in the next year, and half could reduce their own pay to keep their practices sustainable.


GP consulting room (Photo: Robert Johns/UNP)

GP consulting room (Photo: Robert Johns/UNP)


In a GPonline poll of 217 partners 61% said their practice would consider reducing the use of locums in the coming year to maintain profits or sustainability. Just under half (47%) will consider cutting their own take home pay.

Over a third (35%) of partners said they would consider reducing patient services, while a fifth said they could freeze staff pay. More than one in 10 respondents said they may have to consider staff redundancies.

Practices are considering the drastic measures despite evidence from official data last week that GP funding rose by 3% in real terms across the UK in 2016/17.

GP leaders said that despite increased funding secured by the BMA in contract negotiations practices across the country were still ‘struggling to cope with rising patient demand that is far outstripping current resources’. The GPC is calling on the government to speed up promised additional investment, and has warned that current projections suggest the profession will remain £3.4bn short of the funding it needs by the end of the decade.

Related: Why It Makes Sense To Look At Paramedics For General Practice

GP partners also told GPonline in the survey that they will also consider delivering services differently in the next year to cope. Over half said they could increase the skill mix at their practice, while over a third (34%) said they could increase the amount of non-NHS work they take on. A quarter said they could merge their practice with another.

GP crisis

One GP partner said: ‘I think most practices are only one GP away from a crisis - whether that be retirement or illness. We have spent a fortune on locums and are limited when we take annual leave.’

Another added: ‘Core services not enough to sustain profitability. Additional services commissioned by the CCG are needed but they are now being devious by linking these additional services to work not wanted by practices like poorly funded extended hours work. You have to do all or nothing. This is an underhand way of making practices do work that they do not want to do and is non-profitable.’

But another GP said: ‘I am ever optimistic that we will make it work for the future.’

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Planned changes to CQC inspections will increase GP workload, RCGP warns

31 August 17

By David Millett on the 30 August 2017

The CQC's proposals to overhaul GP inspections next year will put an extra administrative burden on practices, the RCGP has warned.

The changes to the CQC’s inspection regime, which are due to be introduced from next year, ‘will not reduce the overall impact of regulatory burden on GPs’ and will actually increase practice workload in the short-term, the RCGP said.

Plans to press ahead with making practices provide annual information to the CQC as part of a more collaborative approach to regulation were ‘disappointing’, RCGP vice chair Professor Martin Marshall said.

The warning comes as the CQC sent a letter to all practices on Wednesday, which revealed its new system where practices will collect and submit their own information to the regulator will be introduced ‘during 2018’.

If no concerns are raised by the data, practices that are already rated good or outstanding will be inspected once every five years instead of every year.

But the RCGP said this new requirement would add to practices' workloads instead of reducing the burden of regulation.

The CQC said it was working with the GMC, NHS England and other regulators to 'streamline' requests for data, avoid duplication and share information.

Inspection overhaul

'Inadequate' practices will continue to be inspected within six months of their previous inspection, and 'requires improvement' practices within one year.

Additional details on the CQC plans to overhaul the GP inspection regime will be published this October. with rollout of the changes to be phased in gradually from November, the CQC letter adds. The regulator said it expected the new assessment framework to be introduced in November.

It follows the CQC’s consultation on the plans, which concluded in early August.

Professor Marshall said: ‘The CQC proposals are very disappointing, especially at a time when GPs are struggling to cope with unprecedented pressures of increasing patient demand, insufficient investment and severe GP shortages.

'Effective regulation must add value to the care of our patients, not detract or distract from the quality of it. Nor should it divert already limited resources away from hard pressed GPs who are working flat out to provide frontline care.

‘While some of the proposals may make sense in isolation, collectively they do not address the issue of the growing regulatory and administrative burden on GP practices. In the short term at least, the CQC’s proposals could result in an increase in the administrative burden on practices if they are expected to provide additional information and keep it up to date.

Regulatory burden

‘Parts of the proposed new approach will be welcomed by GPs and their teams, particularly the longer interval between inspections for good and outstanding practices. However, the overall impact of the regulatory burden on GPs will not be reduced by these proposals and they are not sufficient to make a significant difference to the day-to-day workload and working lives of GPs.

‘We have raised these concerns in our response to the CQC consultation and will be pressing for these to be more fully reflected in the CQC’s proposals.'

Professor Steve Field, CQC chief inspector of general practice, said: ‘We have written to practices to update them on our inspection programme and the consultation on our new approach. In the consultation document we outlined several ways that we think the inspection programme could evolve to do what it needs to do more efficiently, while recognising the pressures faced by GPs.

‘The changes are subject to the outcome of the consultation, so we are not in a position to say precisely what these changes will look like.

‘However, we are working closely with RCGP and BMA on the detail of our proposals so that any changes following the consultation are implemented in such a way that recognises the pressures faced by GPs and minimises the impact on their workload.'


The original post can be found here

Do you work or know anyone who works in Primary Care?

14 August 17

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One-week waits for GP appointments to soar over next five years, warns RCGP

25 July 17

Patients will wait more than a week for an appointment at their GP practice on more than 100m occasions by 2022 - posing a 'genuine risk to patient safety', the RCGP has warned.


Professor Helen Stokes-Lampard (Photo: Pete Hill)

Professor Helen Stokes-Lampard (Photo: Pete Hill)

Soaring pressure on general practice - with a growing workforce crisis, rising workload and a decline in funding over the past seven years - is undermining practices' ability to offer timely access to appointments, the college warned.

The college said the crisis facing general practice was a 'case of national concern' that would increasingly put patients at risk.

In 2016/17 there were 80m cases when patients had to wait more than a week to see a GP or a nurse at their practice, but by 2021/22 this figure will rise to 102m if current trends are allowed to continue, the college warned.

GP access

Analysis of NHS patient survey data by the college also revealed significant variation between CCG areas in access to general practice.

More than a third of patients wait a week or more on average for an appointment in some CCG areas, the college warned - including Corby and Fareham and Gosport. In around one in 10 CCG areas across England, a quarter of patients wait more than a week to see a GP or a nurse.

Related post: How-paramedics-can-help-general-practice

In Bradford, where GP access figures are the best, one in 10 patients are still waiting more than a week for an appointment, the college warned.

The college called on the government to accelerate investment promised in the GP Forward View, warning that the profession was struggling to cope with a 16% rise in workload and a fall in funding since 2010.

Patient safety

RCGP chair Professor Helen Stokes-Lampard said: 'Our patients should be able to see a GP when they need to, so we’re highly concerned that patients are finding it so difficult to make an appointment, and that in so many cases they have had to wait more than a week to see a GP. This is a clear risk to patient safety – and if nothing is done soon, it is clear that this is set to get worse.

'If these patients can’t secure an appointment with their GP when they need one, it’s probable that they will return at some point to another area of the NHS, when their condition may have worsened, and where their care will cost the health service significantly more – something which could’ve been avoided if they’d been able their GP in the first instance.

'GPs and our teams are now making more patient consultations than ever before - over 370m each year - and with workload continuing to escalate, and with continuing resource and workforce pressures, the worrying outcome is that we will be unable to see all our patients who need to be seen.'


Original post by Nick Bostock on the 24 July 2017

More than 200 GP practices closed or merged in past 12 months

19 July 17

Practice closures and mergers are at record levels (Photo: iStock)

Practice closures and mergers are at record levels (Photo: iStock)


New analysis published by NHS DIgital showed that 202 practices were closed or merged in the year to 30 June 2017. Just 8 new practices were opened in that time.

A regional breakdown of the figures showed the north of England suffered most losses, around 64, with the south of England losing 54, the Midlands and East losing 45, and London 39 GP practices.

More than half of CCGs, 53%, had no practice closures or mergers in the last year.

GPC acting chair Dr Richard Vautrey said: ‘This confirms what we've been repeatedly saying and provides further clear evidence of a service at breaking point.


Related News: Community Paramedics Delivering New Model Of Care


GP crisis

‘With over 200 practices closed or merged in the last year and many more struggling to manage their workload pressures it is time for government and NHS England to step up their efforts to resolve this crisis before even more patients lose their much loved local GP service.’

The NHS Midlands and the East region saw five new practices open over the year, with two in the North of England region and one in London.

The new official data confirm recent estimates by GP leaders and GPonline.

GPonline analysis of official data in June concluded that 671 practices had been lost since 2013. Analysis in April suggested that over 220 had been lost since January 2016.

An investigation by GPonline in August 2016 revealed that the total number of contract terminations increased from 54 in 2013/14 to 158 the next year and up to 192 before the end of 2015/16.

Vulnerable GP practices

Figures obtained by GPonline in March 2016 revealed that 811 practices, over 10% of the total number in England, were identified by local NHS England as vulnerable, with some areas reporting more than 20%.

The BMA began balloting practices on Monday on their willingness to participate in a co-ordinated list closure as a form of industrial action in response to what they say is the faillure of NHS England's £2.4bn GP Forward View to ensure sustainability of the service.

Polling by GPonline suggests a majority of GPs would be prepared to take part in a co-ordinated list closure to highlight pressure on the profession.


Related News: How Paramedics Can Help General Practice


RCGP chair Professor Helen Stokes-Lampard said: 'It’s not clear with these figures why practices have closed – some may have merged, and others may have closed as a result of working "at scale", which can bring benefits for patients through pooling resources to provide additional services or better appointment access.

'But this won’t always be the case and when practices are being forced to close because GPs and their teams can no longer cope with ever-growing patient demand without the necessary funding and resources, it’s a huge problem.

'More research into why practices are closing would be really useful – but ultimately, we need the pledges in NHS England’s GP Forward View, including £2.4bn extra a year for general practice and 5,000 more full-time equivalent GPs by 2020, to be implemented in full and as a matter of urgency.'

Original story by Neil Roberts on the 14 July 2017 @

Government cuts have forced councils to reduce planned spending on public health services by £85m in

13 July 17



Acting GPC chair Dr Richard Vautrey

Acting GPC chair Dr Richard Vautrey


Analysis by the King's Fund, based on data from the Department of Communities and Local Government, shows that councils in England will spend £2.52bn on public health services in 2017/18 compared to £2.60bn the previous year, on a like-for-like basis.

Once inflation is factored in, the think tank estimates that planned public health spending will be more than 5% lower in 2017/18 than it was in 2013/14.

GP leaders condemned the cuts as a 'national scandal' and warned that they could see money diverted away from practices and create short- and long-term workload problems for GPs.

Public health cuts

The £85m reduction in spending comes on top of cuts worth £200m made to public health in 2015/16. Funding for sexual health services has dropped 10% over the last four years.

Sexual health services are set to be slashed by £30m as part of the cuts, a 5% reduction on last year’s budget, the King's Fund report said.

This comes alongside a projected 5.5% cut to tackling drug misuse in adults – equivalent to £22m – and a 15% cut worth £16m to smoking services.

Most services are facing cuts, it warned, bar a few – including promoting physical activity and some children’s services.

Acting GPC chairman Dr Richard Vautrey said: ‘It’s a national scandal that the government is allowing such significant cuts to public at a time when we need investment far more than ever before.

Long-term consequences

‘We will pay the consequences in the long term if we cut funding now – it’s completely foolish to cut these services at this stage.

‘These cuts could take money away from GP services – many practices are reliant on money that comes from public health sources, doing important work around smoking cessation and reducing alcohol. Sexual health and contraceptive services are also funded through public health sources from local government.

‘In terms of GP workload – in the short term, there's always the risk practices will try to maintain services even though they have funding, which will impact on the services they can provide.'

GPonline reported earlier this year that GP practices deliver services that should attract enhanced services payments worth millions of pounds a year for free.

Dr Vautrey added: ‘And if we’re not offering basic services now, it is bound to increase workload pressures on GPs and community-based healthcare in the long term.’

Frontline GP services

RCGP chair Professor Helen Stokes-Lampard described the cuts as ‘incredibly concerning’.

She added: ‘We know that difficult financial decisions need to be made but it makes no sense to make cuts to these frontline services, and other valuable services for patients, that will only be to the detriment of the wellbeing of so many and could adversely impact on the health and wellbeing of some of our most vulnerable patients in society.’

Shirley Cramer, chief executive of the Royal Society for Public Health, said: ‘Short-sighted cuts to sexual health, drug misuse and stop smoking services are a false economy – saving money in the short term but costing far more over coming decades, while jeopardising precious gains we have made to cut the number of smokers and efforts to tackle our growing crisis of drug-related deaths.’

Izzi Seccombe, chair of the Local Government Association's community wellbeing board, said: ‘Councils are clear – the government needs to look to prevention, not cure, for delivering long-term savings and better services.

‘To take vital money away from the services which can be used to prevent illness and the need for treatment later down the line is counterproductive.’

A DH spokesman said: ‘We have a strong track record on public health – cancer survival and dementia diagnosis are at a record high whilst smoking rates and teen pregnancies are at an all-time low.

‘Over the current spending period we will invest more than £16bn in local government public health services. Moreover, we have shown that we are willing to take tough action to protect the public's health – introducing standardised packaging of cigarettes, a soft drinks industry levy and a world leading childhood obesity plan.’

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