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

2. 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

3. 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

4. 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 NHS Digital, General and Personal Medical Services, England September 2015

5. Governance challenge to STP planning & delivery?
44 STPs were formed in December 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

6. 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

7. 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 All pharmacists trained by March ’17

8. 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

9. 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

10. 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

11. RCGP Election Manifesto
The College’s election manifesto is called Six Steps for Safer General Practice
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

12. 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?
@MarshallProf