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Enhanced GP Services Workstream

Firstly we apologise for the length of this news item , but this is one of the most important messages I have sent in my time as Birmingham LMC secretary; please do read it, and the two documents below, very carefully.

The first document is the Birmingham and Solihull STP’s proposal for an “ enhanced GP services” workstream for general practice. Whilst this is of particular relevance to those GPs and practices in Cross City and Birmingham South Central CCGs, I am also sharing it with Sandwell and West Birmingham CCG practices as the key issues apply to all practices, and no doubt, a similar proposal will also be produced, indeed may already have been produced, by the Black Country STP which covers SWB practices.

This document has only just come to the attention of the LMC indirectly; there has been no consultation with the LMC, nor to my knowledge with any representatives of GPs or practices as providers (although there has obviously been CCG representative input form the commissioning perspective) in the production of this strategy document, which, you will see, is proposing fundamental and far reaching changes in the way general practice is delivered. It would appear that plans by the STP to transform general practice, and transfer massive amounts of secondary care work into general practice, are already very far advanced indeed, and only at this late stage have been shared with GP provider representatives. I would urge you all to read this document very carefully and consider the implications for your practice and its future.

As per the point I made in the email I sent last week ( copied below), about the transformation tail wagging the sustainability dog, whilst no one doubts the need for changes in the way general practice, and indeed wider NHS care are delivered, it is clear that the proposals in the document are seeking radical transformation without fully recognising or paying due regard to the need to properly support general practice in order that practices remain viable and sustainable. One might use a metaphor of making grand plans to build an extension, a conservatory and a loft conversion whilst the foundations of the building are crumbling, the land upon which it is built is rapidly subsiding and without the occupants of the building being consulted.

Whilst the document does pay some lip service to the need for CCGs to have a “robust framework for ensuring core general practice services…whilst this work is being developed” there is no detail here about any additional recurrent funding for core GP services, which is a requirement to make practice sustainability a reality. Such funding should, of course, be coming nationally through adequately funded GMS and PMS contracts but the reality is that it is increasingly unlikely that this will be delivered by either the government or NHS England. It also seems increasingly clear though that the CCGs are not going to be investing the additional resources required to enable the continued safe and sustainable delivery of essential GP services. In any case the message that the CCGs are now sending out is that they are unable to commit any additional investment into general practice without the approval of their STP!

Unsurprisingly, therefore we have a situation where, as per the concerns I raised in last week’s email below, the plans to transform general practice and shift work out of hospitals are being given precedence over the sustainability and viability of core general practice to deliver them. The LMC’s view is that plans for transformation simply cannot be delivered without the required investment and other support in order to ensure core general practice viability and sustainability. Nor, it goes without saying, can they be delivered without the full support and consent of GPs and practices.

It is critically important that all practices, and the LMC as their representative body, fully engage with the STP , advising and assisting the process but also challenging all STP proposals and unless it is clear that all “ transformation” is indeed necessary and appropriate, and that only change that which has the full support of general practice and which ensures core general practice and sustainability, is carried through. All of this of course is in the context of NHS England’s “GP Forward View” document which acknowledges, at least partially, the extent of the underfunding and crisis in general practice and commits to increase investment to aid practice sustainability.

With that in mind, Birmingham LMC Chairman Dr Bill Strange has produced the second attached document in this email. Again I would urge you all to read this document very carefully. This is a simple “ traffic –light” tool, which can enable any proposals put forward by the STP, or by CCGs, to be assessed to ensure that not only do they commit the required amount of additional resource for any transformation of services and transfer of additional work into general practice, but that they first and foremost also ensure the extra funding required for general practice to deliver safe and sustainable essential core services and deliver on the GP Forward View commitments. The LMC will use this tool to assess any new plans to expand general practice workload in the city and would urge all practices too to use the tool to assess the individual impact of any proposed changes or developments on their own practices and to hold STP and CCG proposals to account for delivering on GP Forward View commitments.

The traffic light tool is also being shared with all West Midlands region LMCs and with the regional RCGP faculty and “STP ambassadors “ in order to help ensure a robust and unified voice for general practice across the region.

Please do not hesitate to contact the LMC for any advice or with any comments about this.

Click here to download the document "An introduction to the traffic light system for Birmingham GPs".

Click here to download the document "Enc 9 Enhanced GP Services Workstream v1 4 (002)".


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