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The King’s Fund calls for an end to “adversarial approach to commissioning”


5 May 2016

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A health think tank is calling for an end for “adversarial approach to commissioning” because general practice faces a crisis of increasing workloads, funding shortfalls and problems in recruiting and retaining staff.

A health think tank is calling for an end for “adversarial approach to commissioning” because general practice faces a crisis of increasing workloads, funding shortfalls and problems in recruiting and retaining staff.

The King’s Fund report, Understanding pressures in general practice, said “general practice is in crisis” and prescribed streamlined commissioning to reduce the burden on general practice after practice managers reported the “nightmare” in chasing up piecemeal payments.

The report’s researchers looked at data from 30 million consultations at 177 practices and spoke to staff including GPs, practice nurses and managers and trainee GPs about the pressures they faced.

Consultations in general practice grew by 15% between 2010 and 2015. Telephone consultations soared by 63% and face-to-face consultations grew by 13% over the five-year period.

The GP workforce grew by just 4.75% and practice nurses increased by 2.85% but the NHS overall budget fell from 8.3% to 7.9%.

Other factors contributing to the crisis included a failure to keep pace with the over 65s and over 85s who are most likely to use primary care, consumer demand for immediate care and changes in community nursing, mental health and more work from care homes.

Researchers said workforce planners need to be aware that GPs are considering “portfolio careers” rather than full-time work in general practice as they are put off by the risk of stress and burnout.

The report criticised the Department of Health and NHS England in collecting data that would have given them advance warning of the crisis. Lead author Beccy Baird (pictured) said: “Commissioners cannot plan effectively or understand the impact of their decisions unless they understand how GP practice is changing.”

She noted it was too early to tell the impact of the 2015 move to delegate powers to clinical commissioning groups (CCGs) to design contracts and management of offer local incentive schemes as an alternative to Quality Outcome Framework, Local Enhanced Service and Directed Enhanced Service.

CCGs told researchers they had less ability to offer practical support such as triaged phone systems that primary care trusts offered.

Baird recommended putting general practice at the heart of the sustainability and transformation plans to ensure its voice is heard.

The report also called for “radical change” with innovative models of general practice such as multispecialty community providers, with practice teams collaborating over patient care.

Baird stressed the importance of adequate staffing.

“Otherwise, it will run the risk of spreading an already stretched workforce across longer working hours, thus increasing the workforce challenges.

“If general practice is to remain at the heart of the NHS, it must have an adequate and stable funding stream for core services,” said Baird.

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