"He who is not courageous enough to take risks will accomplish nothing in life." Muhammad Ali, World Heavyweight Boxing Champion
Almost two weeks on from the General election and with the dust beginning to settle, I am now being asked what is the likely impact for General Practice as a result of the election, and what “noise” am I picking up from within my network of contacts?
My observations are:
1. The ongoing pay freeze, with no real investment until 2018/19 at the earliest. The promised £8 billion will only enable the NHS to stand still; consequently, it is not new investment;
2. Further reductions in QoF income, tied to ever higher thresholds to achieve indicator targets, or possibly the scrapping of QoF completely;
3. Any Qualified Provider contracts for services, many of which that would have been LES agreements. This is simply another erosion of income, unless CCGs change their approach, or practices respond to this quickly by combining to bid at scale;
4. MPIG – being phased out in the next 6 years, which is having a disastrous impact in many areas. Nothing new has been announced to replace this income;
5. PMS reviews, which are also having a major impact in many areas, with Practices on the edge of toppling over. We are promised the money will be reinvested but as yet this is a “no show” in any of the areas I work in;
6. Seven day opening, which is now certain following the election result, as was highlighted this week with a speech from David Cameron reaffirming this commitment;
7. Levels of unfunded work, which continue to increase unabated with other providers seeking free of charge input from General Practice. Co-commissioning should resolve this; however, as yet I have seen nothing to suggest it will. This means General Practice has to act, or you risk the unintended consequence of sending a message to the health economy that General Practice is open to taking on as much free of charge work as they can send you;
8. The workforce crisis, which ties directly back to lack of investment, where General Practice has gone from receiving 11% of the NHS budget to under 8%. Very few people I know want to work in a swamped and highly pressured environment on a daily basis.
The key point in all of this is how does General Practice respond to the challenges? Running harder is out of the question, much as it appears to be the only answer in the NHS with CCGs, NHS England, the Department of Health and the Government all expecting more and more work to be done by General Practice without any new real investment.
Consequently, the time has arrived for General Practice to own its own future; there is nobody else out there who can shape the future General Practice wants and needs.
For those practices that haven’t already made a decision about what the future looks like and made a plan to achieve that, the time is now, to take some time out and decide what the best route is for your practice. It doesn’t matter what the practice down the road is doing; this is all about what is right for you and your team. Options to consider might include, for example:
- Undertaking vertical integration with the local hospital, where the practice team becomes salaried to the hospital. This of course means pay and conditions and no real control over what you do and don’t do, or perhaps more importantly, your workload. You could end up working 7-day “shifts”, as described by David Cameron in his speech on 19th May.
- Opting for a merger with other local practices to form a Super Practice, which again means a new way for working, with a degree of ceding of control to others, and a larger number of people needing to be in agreement to make changes.
- Federating, which would allow the Practice to retain control over its own core contract, but also allow it to work with other local practices to run services beyond core contract. In this model all Practices remain the sovereign body, only coming together through the federation when we need to work at scale across the entire population. A federation will also support practices to rethink their delivery model to develop the General Practice of the future.
What is absolutely clear is that unless you are in a very small minority, where you are completely happy with everything happening within, and to, your Practice you have to be prepared to change. That leaves only one question: which of the options above suits you best, or do you have an alternative option?
The key is General Practice badly needs fresh thinking, and it needs to be prepared to work in a different way, given the financial and infrastructure limitations; it also needs to embrace technology. CCGs will undoubtedly develop lovely documents on Primary Care Strategy BUT they haven’t got the skills to implement change – General Practice has to lead, own and drive this. It’s your work environment so why would you not want to own what happens to it?
"When everybody tells you that you are being idealistic or impractical, consider the possibility that everybody could be wrong about what is right for you.” Gilbert Kaplan
If you are thinking about federating, and would like more information on how BW Medical Accountants can support you in forming a federation, or the on-going support we provide to enable federations to generate income, call 0191 653 1022 and ask to speak to Keith Taylor or Scott McKenzie. Alternatively email enquiry@bw-medical.co.uk