General Practice: The future in rural areas Richard Vautrey Chair, BMA GP committee England Chair, BMA GP committee UK

Share of NHS funding invested in general practice (excluding drug reimbursement) *2005/06 to 2007/08 – assumed investment excluding drug reimbursement represents 92% of total investment 2 January, 2019

GP workforce – Sept 15 to June 18 2 January, 2019

General Practice Staff – Sept 15 to June 18 A number of employers did not state what type of nurse they employed in March 2016 – hence the anomaly in the graphs above. The vast majority of those that did not have their type stated were not practice nurses, but it was easier to illustrate them here rather than include them in the graphs for ‘other nurses’ on the next slide. The general trend for practice nurse numbers being in decline is still evident. *Provisional figures count practice nurses and trainees together 2 January, 2019

General Practice Staff – Sept 15 to June 18 2 January, 2019

2 January, 2019

General Practice: the foundation for a sustainable NHS Sustained and significant funding investment More GPs, nurses, clinicians and support staff Building collaborative teams in each locality Manage workload enabling quality consultations Indemnity covered Premises and IT development Building on the foundation of a GMS contract Culture change in the NHS

Rural practice - proportion of dispensing and non-dispensing UK 2016/17 At 41.4% number of dispensing practices increased by 0.6% Reverses falling trend for four years Less than 55.5% in 2011/12

Rural GP contractor earnings UK 2016/17 GPs in rural practices have had higher gross earnings and expenses since estimates first produced in 2004 Rural GPs income lower than urban GPs for first time since 2012/13 2 January, 2019

Rural GPs combined earnings UK 2016/17 Income for all rural GPs combined is 3% higher than urban GPs Income increased for GMS rural (1.8%), GMS urban (2.5%) and PMS urban (4.2%), but fell for PMS rural (-0.1%) 2 January, 2019

GP earnings by rurality and dispensing status UK 2016/17 2 January, 2019

Rural challenges Rural deprivation Social isolation Economies of scale Workload Recruitment and retention new medical schools targeted training grants international recruitment GPs in partners/spouses also professionals with employment requirement 2 January, 2019

Rural challenges Primary care networks Extended access Urgent care Dispensing pressures Premises Broadband and IT capability and capacity e.g. video consultation 2 January, 2019

All-party parliamentary group on rural health and social care inquiry What are the needs of rural communities and how do they differ from urban communities How are rural health and social care needs currently met? What is not working in rural communities and why Workforce challenges and opportunities? Education and training challenges and opportunities? Structural challenges of fitting current delivery models in to rural settings with different needs and challenges? Technology opportunities and challenges? Integration opportunities and threats? 2 January, 2019