GP Forward View The RCGP Perspective Professor Martin Marshall Vice Chair, External Affairs

Finances: 10 years with no growth of investment in GP NHSE - no growth in real investment in General Practice for 10 years to 2015/16. Decline in real spend 2005/06 to 2014/15. Yet demand for services grew c.2.5% p.a through this period - so by 1/5+ overall. But trust deficits have grown = competition for headlines + finance? P11 GP Forward View 14% real growth projected for the period 15/16 to 20/21 = nominal increase in spending of c£2.4bn p.a or 25% GPFV Document King’s Fund Research

No change = huge “do nothing” deficits by 20/21 Growth in demand and acute deficits at the heart of health projections *1 = Health only estimate based on average health spend in STPs where health and social care costs are separately disclosed *2 = Social spend estimated based on national average derived from STPs where health and social care costs are disclosed Source: RCGP and STP Plans

Challenges compound e.g. Single practices and GPs 55+ High relative exposures: 5 Midlands STPs flagging as above average for both single handed practices and retirement threat. Mid S Essex and The Black Country are by a margin the two most challenged STPs in England in this regard NOTES NHS Cumbria CCG crosses two STP footprints (West, North and East Cumbria and Lancashire and South Cumbria); therefore the results for both of those footprints are split proportionally, based on the understanding that the former comprises 61% of the CCG and the latter comprises of 39%, as indicated in the STPs. All figures relating to GPs relate to all GPs, apart from GPs aged 55+, which excludes retainers, registrars and locums. SOURCES GP and practice data relates to March 2016. NHS Digital, General and Personal Medical Services, England September 2015

Governance challenge to STP planning & delivery? 44 STPs were formed in December 2015. They represent 600+ Stakeholders: 207 CCGs, 254 Trusts and major councils/local authorities. As new organisations some of the larger STPs are huge and this represents an obvious governance challenge Organisational advantage to smaller STPs? Source: RCGP and STP Plans

How is the College monitoring GPFV? 33 regional RCGP Ambassadors appointed at GPFV launch in April 2016 to influence, monitor and evaluate local plan formulation and implementation Policy and Engagement team fully committed to reporting on GPFV delivery RCGP GPFV Interim Review – published late January 2017 What is next ? Annual Review of GPFV – expected to be published post election

Interim review short term pledges: good progress Care redesign Good progress in helping practices support people living with long-term conditions to self-care. Workload Further £16m to help GPs’ access to mental health support. CQC fee increase for 2017/18 covered. Sentinel indicators published Workforce NHSE’s Induction & Refresher scheme for returning to work. Increased numbers since the monthly bursary was increased. NHSE and HEE pledged to evaluate the Targeted Enhanced Recruitment Scheme, which offers £20,000 salary supplements to GP trainees. This has resulted in overall fill rate of 86.07% in hard to recruit areas Tech and IT NHSE pledged 16/17 additional support to practices : stamp Duty Land Tax; VAT on premises; transitional support where practices have seen cost rises on leases. Changes to core IT requirements are being implemented The completion of the rollout of access to the summary care record to community pharmacy pledged by March 2017. All pharmacists trained by March ’17

Interim review short-term pledges: weak progress In need of improvement Inadequate £322m in primary medical care allocations, an immediate increase in funding of 4.4% Practice resilience programme with £16m available in 2016/17. Tackle rising indemnity costs in general practice Increase GP training recruitment to 3,250 per year Improve the Induction & Refresher scheme for doctors returning to general practice. Improve the GP Retainer Scheme £16m new national service to improve GPs’ access to mental health support Improve the interface between hospitals and general practice. Reduce the burden of CQC inspection Compensation for future CQC fee increases Review of the Quality and Outcomes Framework (QOF) Fund up to 100% of the costs of premises developments (previous cap of 66%) Note not all pledges included

Interim Review: STP evaluation The GP Forward View is not mentioned at all in a number of STPs STPs are often driven by the need to tackle large deficits in the hospital sector, with very optimistic financial forecasts General practice is frequently seen as a solution to problems in secondary care, without sufficient efforts made to stabilize and support it Workforce plans for general practice are not sufficiently robust Some STPs foresee a decrease or stagnation in GP numbers Local demand for extended access is seldom being assessed STPs with no reference to the GP Forward View: • Bedfordshire, Luton and Milton Keynes • North Central London • Shropshire and Telford and Wrekin • West, North and East Cumbria

Interim Review: Key Recommendations Government to maintain commitment to transformation and GPFV NHSE & HEE to back GPFV pledges and tackle delays. NHSE/HEE also to require clearer timeframes and accountability GPFV delivery in STPs has to be monitored and evaluated. There should be a GPFV outline in every STP or pushback of plans. STPs should show clear financial commitment to GPFV. This should result in CCG outlines of increased investment in GP There has been too little engagement. GPFV communication needs to increase

RCGP Election Manifesto The College’s election manifesto is called Six Steps for Safer General Practice www.rcgp.org.uk/campaign At least 5,000 more GPs by 2020 The promised additional £2.4bn per year in general practice by 2020 EU healthcare workers in the UK protected after Brexit GP specialty training extended to at least 4 years Solution to the rising cost of GP indemnity insurance More nurses, pharmacists and mental health therapists

Some questions: What’s the right balance between doing things better, doing things differently and providing additional resources? Do we agree that the priority is to build capacity and capability for the future rather than sustain current services? Are STPs the real thing? What does general practice have to do to shift resources from the acute sector into primary care? What can the College do to help you deliver in your patch? martin.marshall@ucl.ac.uk @MarshallProf