GENERAL PRACTICE IN BIRMINGHAM: PART 1 of 5
The 2016 Annual Report of the Birmingham Local Medical Committee was published in March 2017. It was a year that had seen further massive change and unprecedented challenges for Birmingham GPs and their practice, clearly reflecting common issues across the country. During the year the LMCs’ constituents sought advice and support more than ever before, reflecting the huge and diverse problems now facing general practice and the wider NHS. The report has been divided into a series of five blogs which will be published separately over the next few weeks covering:
WORSENING GP CRISIS, CCGs AND CO-COMMISSIONING
The ongoing crisis of GP workload, workforce and funding continued to worsen and reached catastrophic proportions during 2016. The Birmingham LMC dealt with an escalating workload, supporting and advising practices and partnerships, many of which were struggling to deal with various consequences of the inexorably worsening situation. A number of Birmingham practices closed during the year; increasing numbers of others recognised the urgent need to merge or to join one of the of city’s super-partnership organisations or federations in order to help safeguard their viability.
None of the funding promised by NHS England in 2015, as part of its vulnerable practice programme, managed to reach any practices during the year, despite the LMC’s best endeavours to assist NHS England and the CCGs in this process. A number of other funding streams were promised by NHS England in 2016 as part of its GP Forward View (GPFV) plan to support general practice. Whilst the commitment to this additional investment was most welcome the LMC repeatedly made clear that these various, limited pots of additional non-recurrent funding were not solutions to the severe problems facing general practice, which could only be resolved by massive increases in recurrent core practice funding to enable the necessary increases in GP numbers, practice staffing and capacity. The GPFV funding streams included the resilient practice programme. Whilst recognising and making clear that what was available would go nowhere near to resolving the many dire problems facing general practice, Birmingham LMC engaged with NHS England and the CCGs in order to ensure that those practices in greatest need of urgent support were identified.
As in previous years, it became abundantly clear that the focus of the government and NHS England was not on supporting the safe delivery of general practice during core hours, but of increasing the availability of routine appointments at other times, as well as continuing the massive shift of inadequately funded work out of hospitals and into the community. The LMC was tireless in pointing out to commissioners that such policies were wholly inappropriate and would not resolve the broader issues caused by NHS underfunding and a decade of destructive policies.
The LMC worked closely with the three Birmingham CCGs through attendance at their Primary Care Co-Commissioning Committees and also with regular liaison meetings, in order to help ensure that support for practices through the GPFV and other initiatives was maximised and used appropriately. This ensured that there was early discussion and consultation with the LMC over many policies and initiatives affecting general practice. In particular we were able to input positively into the new policies for the commissioning of procedures of limited clinical value (PLCV) and the new non-urgent patient transport policy, ensuring that the revised policies properly recognised the perspective of general practice, did not inappropriately add to its workload burden, and, with respect to the PLCV policy, recognised the right of GPs always to be able to refer for a specialist assessment and/or opinion.
Unsurprisingly, and true to form in light of the experience of the last few years, the year brought news of yet another massive upheaval for the commissioning of GP services, with the announcement that Birmingham Cross City and Birmingham South Central CCGs would enter into a “functional merger” with Solihull CCG, to form a single joint commissioning board with a view to a formal merger of the CCGs in 2018.
This news inevitably brought further complications to the landscape of commissioning of general practice in the city, with practices in West Birmingham continuing to have their contracts held by Sandwell and West Birmingham CCG, but with the practices in the rest of Birmingham now set to share a commissioning organisation with Solihull. A “Joint Commissioning Board “ was put in place at the end of the year, and the LMC met with its interim chair in order to develop relations and gain clarity over the way that general practice would be commissioned in Birmingham going forward. It was anticipated that an accountable officer for these new arrangements would be appointed early in 2017, together with the putting in place of a ” Primary Care Co-Commissioning Committee in Common” for the three CCGs. It remained to be seen what benefits, if any, the new commissioning arrangements would bring about for general practice in Birmingham.
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