The below from UHB’s chief executive Dr David Rosser has been sent by BSOL CCG to its member practices, but the significance of this for all practices across Birmingham is such that I feel it and my message on this must be shared with practices in SWB CCG too.
I have, unsurprisingly, already fielded a massive number of concerns from practices about this, and spoken to Paul Jennings, BSOL CCG chief executive. This policy document publication, and subsequent media announcement have taken place without consultation with general practice, its representatives, or CCGs and, needless to say this is one of the most concerning documents I’ve ever read in respect of potential risks to general practice in the city. That it should come, without warning, from an organisation ostensibly working in partnership with general practices and BSOL CCG in the STP, and is flying in the face of the current development of PCNs and their aim to bring about primary-care led integration of out of hospital care is simply staggering.
Whilst it remains unclear as yet exactly what UHB’s intentions are, it would certainly appear to be that one aim is to replicate in some way the Babylon/GP at Hand model of general practice (with all the many concerns about this we are all aware of) and to do this within a vertically-integrated UHB-led system (again with all the massive implications this brings with it). In addition there would appear to be an intention to support the aim of the GP at Hand practice gaining a strong foothold in Birmingham and to work in strong partnership with it. All this needs to be taken in the context of 1) GP at Hand commencing operating in Birmingham in June; 2) Sandwell and West Birmingham Hospital having already been awarded an APMS contract in Birmingham (and others in Sandwell); and 3) a number of other APMS contracts coming up for procurement in Birmingham shortly.
It’s also noteworthy that in the document Dr Rosser apparently completely fails to grasp the reasons for the concerns over GP at Hand – it’s cherry picking of young, healthy, digitally-savvy patients at the expense of those with the most health needs, both increasing health inequalities and putting the sustainability of traditional general practices at risk, thereby of course further exacerbating the problems. His assertions that these concerns are simply due to GPs worried about their income is at best insensitive and insulting and displays appalling ignorance of the realities of the situation. I have little doubt that in the geographically smaller environment of Birmingham the risks of GP at Hand causing irrevocable damage to general practice, the risks to commissioners, and the risks to the wider health economies in the STPs will be far greater than they are in London, where much havoc has already been wreaked.
UHB clearly recognises the pressure it is working under, and its need to take some action to address this (and of course seems to be putting the blame for its problems fairly and squarely at the door of general practice, rather than on the underlying reasons that general practice is unable to cope with the demands placed on it), but the direction of travel it appears to be taking in seeking a solution is woefully off the mark. Instead it needs to be working collaboratively with general practice, emerging PCNs at-scale GP organisations and commissioners in order to find the required solutions; this needs properly-resourced general practice leading the development of more integrated and sustainable out of hospital care, and not a hospital –led vertically integrated system utilising the massively flawed and damaged GP at Hand model.
A number of practices have asked whether the LMC intends to formally respond to UHB; I am certainly giving considerable thought to doing so, and to the contents of such a response; having said that however, I have my doubts as to how impactful an LMC response might be, bearing in mind that its very clear to me, from an email I have seen, what a low opinion Dr Rosser has of the LMC and its motives. My own view is that separate responses of concern from as many GPs, practices, PCNs and at-scale GP organisations as possible would actually be far more effective, and I do hope that is something that you will all consider; it may be too that a separate joint single response on behalf of all of general practice in Birmingham would have impact too, and that is something to be discussed.
Having said all that, it’s clear that over and above words, some decisive action and radical change, is required to deal not just with this, but with all the massive issues that general practice is now facing. This needs all practices, PCNs and at scale providers to work together as a single team towards common goals, harnessing the opportunities of the developing PCNs of course, but also accepting that everyone too must seize the initiative in respect of providing digital solutions to counteract the threat of GP at Hand, and also ensuring that there are fit for purpose general practice bids for all forthcoming APMS procurements.
All of this will require much CCG support of course and, I believe, an acceptance that there has to be a sea change in funding flows to enable general practice to remain sustainable, to transform and to lead the changes necessary for the entire health economy.
The LMC will, of course, continue to represent and support all GPs and practices and to engage with all relevant partners in order to do its best to help general practice through this, the latest in a very long line of challenges, and with all other current challenges and all the future challenges that will inevitably arise.