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General Practice in Birmingham Part 3

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, their practices and no doubt reflecting issues in other regions in the UK. 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 blogs covering:

PRIMARY CARE SUPPORT SERVICES PRIVATISATION

The LMC had noted in its 2015 annual report the catalogue of problems that had been caused by the cuts to and reorganisation of primary care support services. We also suggested that problems were likely to get even worse in 2016 following the news that the service was to be completely privatised and that NHS England had awarded Capita the national contract to provide primary care support.

Dire as the LMC’s warnings had been, the full extent of the problems caused by Capita’s wholly incompetent handling of primary care support services was beyond even our worst nightmare. Practices spent the entire year having to deal with the fall out of the many problems caused across the entire breadth of primary care support functions including the delivery of medical records, patient registration and removals (including, crucially, incompetent processes for violent patient removals which put the public at risk), payments, the delivery of vital supplies including prescription stationery, needles and syringes, performers list management, pension contributions and just about every element of primary care support function. To compound matters, Capita’s communication with practices was truly appalling, with phone calls and emails invariably unanswered and absent responses to both queries and complaints.

Helping practices to cope with this complete and utter shambles of a primary care support service proved to be one of the major areas of LMC work throughout the year. As well as doing our best to deal with specific practice problems as they arose and were notified to us, the LMC was proactive in requesting that practices report all problems which were then directly taken up by the LMC not just locally but with escalation of all issues to the highest level nationally at Capita, NHS England and the GPC. A number of meetings took place between the LMC and key Capita and NHS England personnel.

Much of the work supporting practices dealing with these primary care support issues was shouldered by the LMC’s new Practice Support and Liaison Manager Wendy Loveridge and we are extremely grateful for her expertise and her sterling efforts on behalf of our constituents. Whilst the LMC was, to some extent, successful in resolving a number of specific practice issues with primary care support services, it was clear throughout the year that there was no improvement in Capita’s performance and it remained an organisation completely incapable of delivering on its multi-million pound contract. The LMC made it clear that NHS England bore ultimate responsibility and accountability both for awarding Capita this massive contract and then for failing to properly hold it to account and ensure that vital primary care support services were properly delivered. It remained to be seen whether the new year would bring any improvement to this appalling mess.

CARE QUALITY COMMISSION

It also came as absolutely no surprise that continuing to help and support practices over issues related to CQC remained a considerable focus of LMC activity during the year. CQC’s programme of practice inspections and its wholly unfit for purpose system of quality ratings continued and the majority of Birmingham’s practices had been inspected and had received an official rating by the year’s end.

The LMC provided considerable advice and support to GPs and practices both before and after their inspections. This work included help with registration issues, providing much guidance to practices once they had received their draft QCQ reports, assistance with completing factual accuracy returns and providing evidence to submit with these, advice on formal challenges to ratings and help with putting in formal complaints about CQC’s inspection teams’ attitudes and actions, with a number of practices reporting that, disgracefully, GPs and practice staff had been reduced to tears by members of inspection teams.

It was inevitable, bearing in mind the context of the difficult circumstances and lack of funding they were operating under, as well as the complete unfitness for purpose of CQC’s regulation of general practice, that a number of Birmingham practices received “requires improvement” or “inadequate” ratings during the year. These practices received more intensive guidance and support from the LMC, in conjunction with their CCGs and with the Royal College of General Practitioners support programme. It was hardly surprising that as a result of some of this activity wider issues related to practice vulnerability, sustainability and viability came to light and there was no doubt that CQC’s practice ratings were more a symptom of the challenging circumstances, lack of investment and many other difficulties facing practices rather than indicating that poor quality care was the fundamental underlying issue.

As a result of this the LMC spent a considerable amount of time helping these practices to consider the issues of their practice sustainability and longer-term strategic direction in addition to dealing with the immediate crises related to their CQC ratings.

As if the problems caused by CQC for practices were not bad enough, the unsurprising outcome of CQC’s sham “consultation” on massive rises in practice registration fees predictably ignored the many concerns raised and CQC instigated a massive rise in practice fees in April 2016. Furthermore ,despite the clear view of respondents to the consultation , CQC announced that the totality of the huge proposed CQC fee rise would be phased in over just two rather than four years, with the expectation therefore that another massive rise would take place in April 2017. Sure enough, at the end of the year, CQC launched another sham consultation on the proposal to raise practice fees by a further massive 75% in April 2017. The nature of CQC’s fee-setting process meant that the smallest practices would bear a far greater burden of fee rises, as would those practices whose list sizes were close to the arbitrary thresholds set by CQC for cliff-edge fee increases.

The LMC formally responded to the consultation, as well as encouraging its constituent practices to do so. The knowledge of CQC’s track record of listening to concerns raised by respondents to its consultations did not however engender much optimism and it is to its credit that the GPC succeeded nationally, as part of ongoing contract negotiations, in obtaining reimbursement from NHS England for practices for the 2016 CQC fee rises.

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