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GP Partnership Review Newsletter Article

GP Partnership Review, Two Years on

Lincolnshire LMC have recently run online sessions for people who want to know more about GP partnership. One of these sessions was about The Partner as Leader, and we were lucky enough o be joined by Dr Nigel Watson MBE, who is the Chief Executive of Wessex LMCs. Nigel was also independent chair of the national Partnership Review on behalf of Department of health and Social Care, NHS England, RCGP, and BMA, which was published in January 2019.

Nigel’s discussion is available to watch on the LMC website if you would like to watch this now. After the session we received some questions from the audience, one of which was “Two years on from the Partnership Review, what has gone well, and what more needs doing?” Nigel has provided an extensive answer which we thought we would summarise for you.

What did the Partnership Review find and recommend?

The key issues identified were:

  • Workload too great
  • Working day has become longer more complex and work more intense
  • Workforce - demand exceeds capacity
  • Risk of being a partner perceive as being too great
  • General Practice given a lower status to hospitals – funding, status, and influence in the system
  • Digital development to support general practice required

The Review had seven main recommendations

  • Recommendation 1: There are significant opportunities that should be taken forward to reduce the personal risk and unlimited liability currently associated with GP partnerships.
  • Recommendation 2: The number of General Practitioners who work in practices, and in roles that support the delivery of direct patient care, should be increased and funded.
  • Recommendation 3: The capacity and range of healthcare professionals available to support patients in the community should be increased, through services embedded in partnership with general practice.
  • Recommendation 4: Medical training should be refocused to increase the time spent in general practice, to develop a better understanding of the strengths and opportunities of primary care partnerships and how they fit into the wider health system.
  • Recommendation 5: Primary Care Networks should be established and operate in a way that makes constituent practices more sustainable and enables partners to address workload and safe working capacity, while continuing to support continuity of high quality, personalised, holistic care.
  • Recommendation 6: General practice must have a strong, consistent and fully representative voice at system level.
  • Recommendation 7: There are opportunities that should be taken to enable practices to use resources more efficiently by ensuring access to both essential IT equipment and innovative digital services.

How well have the recommendations been implemented?

R1- Reducing risk

  • Indemnity- Clinical Negligence Scheme got GPs has significantly reduced indemnity risk
  • Increased numbers of partners since the Partnership Review, partly due to some of the changes introduced as a result of the Review, has reduced individual risk for partners
  • Premises- Premises Cost Directions have not been published. The hoped for “Armageddon clause” which would allow NHS bodies such as CCGs to take over premises from partnerships if requested may or may not be in the new PCDs
  • Limited Liability Partnerships or Limited Companies- if LLPs or Ltd companies could hold GMS contracts this would help, and this is still being looked at by BMA and DHSC

R2- Increase GP numbers

  • GP Fellowships and New to Partnership Scheme- both introduced in 2020 and taken up by many early years GPs
  • Leadership- Many PCN Clinical Directors are middle years GPs and are being funded and supported to develop leadership roles
  • GP retainers and GP Mentors- New scheme to employ experienced GPs as formal mentors for early years GPs has been rolled out and many experienced GPs have taken up this role.

R3- Increase other workforce in general practice

  • Additional Roles Reimbursement Scheme- significant investment in non-GP workforce has come through the ARRS.
  • Community Team Alignment- Community teams now aligned to PCNs, and likely to increase integration with proposed legislative changes.

R4- increased time in general practice during medical training

  • Increased medical school places- this has happened, including Lincoln Medical School
  • Increase GP training time- now GP trainees time in practice increased from 20 to 24 months

R5- Reduce bureaucratic workload and share workload across PCNs

  • PCNs- have been developed since April 2019, though may not be sharing workload yet
  • Address primary secondary care interface- no significant improvement, and pandemic has seen a regression in the progress previously made
  • Capita- slow progress, but problem has been recognised by Government
  • CQC- simplification of inspections and lighter touch reviews have been implanted
  • Appraisals- lighter touch formative appraisal introduced

R6- Representative voice at System level

  • General Practice to be recognised as a specialty- being considered by GMC
  • General Practice to have representation at ICS/STP level- awaiting publication of new legislative proposals for ICSs (due mid-February), but PCNs and LMCs

R7- Improve general practice technology and digital offer

  • Multiple digital improvements have occurred due to pandemic pressures: remote working, video consultations, video conferencing for meetings, virtual ward rounds, remote monitoring etc

Nigel concludes

  • That to make the partnership model more attractive general practice has to be a better place to work
  • Without general practice the cost of healthcare will increase significantly
  • With an ageing population and more people with long term conditions, the challenges will increase significantly in the future – failing to act now will lead to a major crisis in the future
  • General practice needs significantly more resources to help manage patients in the community
  • There needs to be a clear vision for general practice and its role in a new and evolving NHS

There has been significant progress but the areas which still need work are

  • Premises Cost Directions
  • Allowing LLPs and Limited Companies to hold GMS contracts
  • Primary secondary care interface
  • Capita and practice payments
  • General practice as a specialty
  • General practice role in ICS