![]() ![]() Only GPs truly understand their patients, their business, and their challenges. But the starting point for change must be the GPs themselves. There are potential solutions, like operating at scale and partnering with other NHS organisations and they can be made to work, in the right circumstances. A single strategy cannot meet the needs of the widely differing circumstances facing each GP practice, or each local area. Like many intransigent or ‘wicked’ problems – there is no easy answer. So is the answer a takeover by the local NHS acute provider as is the case in Chesterfield or Yeovil? In some cases it may be, but while some brave souls may believe they can make the changes to general practice it has been unable to make itself, it is hard to see a mass movement to take over a service so badly underfunded and understaffed, especially at a time when provider organisations are facing severe deficits and staff shortages themselves. If merger is not accompanied by doing things differently or doing different things, it just means the same problems will exist over a larger area. ![]() They are not delivered simply because the practice is now operating at a greater scale. It creates the potential for delivering efficiencies and new ways of working, but these benefits are not automatic. The local LMC warned other practices, thinking of federating and delivering services at scale, that they needed to be aware of the liabilities they might be taking on. The “answer” in the commercial world after all is nearly always to save costs by operating at scale.īut is this business model risk-free? Reports emerged earlier this year about a federation in Doncaster going into administration after running into financial difficulties when it was unsuccessful in retaining contracts it had previously been awarded. The nearly 8,000 small businesses, many of whom are finding their current business model unsustainable, need to consolidate into a smaller number of larger organisations – federations or alliances are the accepted terms. To outside observers the problems facing general practice may seem quite straightforward. However welcome, the GPFV money is only half the answer to the GP crisis. The GPs to cover current working hours do not exist, and despite the promise of 5,000 more, the colleges are still predicting a shortfall of 10,000 GPs in five years’ time. NHS England wants 12 hours a day, 7 days a week opening in general practice. And for the other half, strings are inevitably attached. But the problem with money is that it gets swallowed up - half of the promised money funds year on year contract rises of less than 5% that barely keep up with inflation of GP expenses (GP indemnity costs continue to rise exponentially). The main strategy seems to be a promise of more money. In April this year NHS England published the General Practice Forward View (GPFV) with a sprawling list of initiatives designed to increase the overall investment in general practice by a recurrent £2.4bn by 2020/21. The problems in general practice have certainly not been ignored, in part due to the threat of mass resignations that coincided with the strike action of the junior doctors. So who will be the saviour of general practice? Does the answer lie in the hands of Jeremy Hunt and the Government? He certainly seems to think so. While in Manchester, the local LMC chair suggests that the primary reason GP practices in Manchester are signing up to the new multispecialty provider (MCP) contract is because they see it as a way out of their current pressures. ![]() In Yeovil, the Symphony Healthcare Services model, where GP practices are run by a company wholly owned by the hospital, is attracting more local practices. ![]() In Chesterfield a number of practices are now the responsibility of the local hospital, which now runs them through the Royal Primary Care banner. The extent of the crisis means something has to give. The impact of escalating demand and unmanageable workload is having a devastating effect, with GPs leaving the profession in significant numbers either through early retirement, or for a career change. That there is a crisis in general practice is not in doubt. ![]()
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