During late November and December 2021 representatives from Londonwide LMCs have continued to meet with MPs, councillors and the police to raise issues affecting practices. We have also submitted evidence on the challenges facing London’s practices to Parliament and are considering responses to further consultations.
Health and Social Care Select Committee inquiry in the future of general practice
Responding to the recent call for evidence on the future of general practice put out by the Commons Health and Social Care Select Committee, Londonwide LMCs reflected concerns raised with us by constituents from across the Capital. Our full response can be read here, a summary of key points is below.
Over the last year London general practices have faced numerous challenges. The workforce is progressively being stretched while trying to stay on top of the increasing population. Practices are dealing with the fallout of decades of underfunding. London general practices continue to be perceived as not working hard, despite recording high numbers of consultations month on month. And inaccurate reporting of workforce headcounts conflates trainees and others that work under the supervision of GPs with full time clinicians to present a distorted picture of general practices’ capacity.
Further points made in the response include:
- To improve the flow of patients through general practice, clear existing blockages, increase capacity and reinforce, maintain and sustain the existing system and workforce, commissioners and educators need to work closely with Local Medical Committees, GPs and practice staff.
- Increasing training and staffing capacity through to improving IT systems and halting system reconfigurations would all benefit staff and patients in a general practice environment.
- Commissioners must recognise the need to extend the core consultation time to at least 15 minutes, if not longer. This would lead to improved outcomes and better staff retention.
- Agreeing to deliver unrestricted work for an inadequate fixed fee is unsustainable. Adequately resourcing practices to have the workforce needed to deliver care safely and work collaboratively and seamlessly with other providers can we give patients the care that they need.
- Despite the reduced GP workforce, we have no way of limiting demand in general practice. We don’t struggle to recruit trainees, but qualified GPs aren’t staying which means retention is a huge problem both for younger GPs not taking up work or leaving the profession, and for older GPs retiring early. The workload pressures are simply intolerable.
- There is a pressing need to prioritise support for practices and invest in core general practice services, rather than increasing numbers of small, often bureaucratic, contracts.
- Remove the bureaucratic barriers preventing expert generalist GPs from referring directly for critical diagnostic tests needed by their patients.
- For the NHS to be sustainable, GPs and practice teams need to be properly resourced so that they can keep people healthy in their communities, meaning so fewer need hospital care.
The Committee will be taking oral evidence in the new year as part of their Inquiry. Further information will be shared on the Committee’s Parliamentary pages when available.
Messenger review
Announced by Secretary of State Sajid Javid as the most extensive review of health and social care leadership for 40 years. The Review is led by former Vice Chief of the Defence Staff General Sir Gordon Messenger, and will report back in early 2022. The Government view the move to integrated care boards in April 2022 and the need for ever closer working between NHS organisations and local authorities as providing an opportune moment to look at what more they can do to foster and replicate the best leadership and management.
The Review will consider what is needed to improve how health and social care is led and managed in England, such as:
- The drivers of performance and the standards expected of good leaders and leadership teams.
- What further powers may be needed to drive real and sustained change, including effective systems for intervention and recovery in both providers and integrated care systems.
- How to help health and care leaders collaborate for more integrated care for citizens.
- Proposals for ensuring the right incentives for the best leaders and leadership teams to take on the most difficult leadership challenges.
- How to more rapidly foster and replicate the best of examples of leadership.
- How to support and improve the skills of all leaders and managers throughout their careers and encourage the best leaders within the system to rise.
- How to draw new expertise and talent into leadership roles in the health and care systems (including the NHS Management Graduate Trainee Scheme).
- How to ensure the right training, opportunities and support for clinicians to take on management roles throughout their careers.
- Whether the right pay and incentives are in place to foster good and excellent performance and recruit and retain the best leaders from start of career to retirement.
- Driving up efficiency – to support leaders, managers, clinicians and wider staff, creating the space and time for them to focus as much time as possible on delivering for patients and care users.
The Review will last four months. Further details can be seen here.
The Future of integrated primary care – Fuller review
Amanda Pritchard, CEO of NHS England, has asked Professor Claire Fuller to lead a wide-ranging national stocktake of how best primary care can be supported within the emergent Integrated Care Systems (ICS). The focus of the work will be on the practical next steps ICS can take as they assume a statutory footing from April 2022. NHS England say will ensuring that primary care takes a central role within ICS and helps to address the current challenges being experienced by its workforce.
The key lines of enquiry will be:
- What are the key priorities for ensuring a more integrated and effective NHS primary care service in future?
- What practical enablers are needed to realise this vision, and how should these best be put into practice?
- What type of leadership, engagement and decision-making structures are needed?
Views on these points should submitted by Friday 24 December.