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How many GPs do we need per 1000 patients? The answer is a very simple one, we don’t know exactly.
What we do know is that we currently do not have anywhere near enough GPs anywhere in the country and the numbers are heading in the wrong direction.
What we do know that with more GPs and a wider primary care team, we can provide a more sustainable primary care service to the public, which in turn has tremendous benefits across the health care system. It is therefore of utmost importance that CCGs are made to see the value of investing in general practice workforce, immediately.
Looking at initiatives focused at retaining GPs, there was never an allocation of posts per head of population because everyone acknowledged it at the time that it’s way more costly to the NHS to lose a GP from the workforce rather than allowing them to join this scheme. The fact that the retainer scheme is in the statement of financial entitlements (SFE) means the funding is recurrent, but CCGs have to keep the money back for this scheme and not spend it elsewhere.
When we agreed the 2016 scheme, almost all CCGs had kicked it into touch (like the I&R scheme) because it was felt that this was a luxury they could no longer afford following swingeing budget cuts. In 2016/17, NHS England put £5 million in to set up the national / regional infrastructure, top up the existing funding for scheme members and practices available through the SFE (Statement of Financial Entitlements) and standardise the governance arrangements / application process etc. In 2017 the SFE was updated to include the new funding amounts. As before, because it’s in the SFE, CCGs have to consider all applications and pay at the rates specified if places are approved. Naturally, they can only approve a fixed number of new scheme members per year, because their budgets are finite, but they don’t really have the option to just refuse to fund any places at all. The scheme never required new money because the money already exists in CCGs’ primary care funding allocations. If your CCG is not investing the money in GP workforce and specifically the retainer scheme, then they must just be spending the money on something else.
The CCGs need to consider the impact of not having enough GPs in the local area, reduce patient access to GP services, how much more it is likely to cost in A&E attendances, avoidable hospital admissions and failure to provide appropriate preventative treatment / care before patients reach much more costly crisis stages of illness. They will fail to demonstrate that its primary care allocation budget does not already include funding for this scheme (it does, but they’ve obviously prioritised the purchase of something else). This particular issue is just a reflection of the difficulties all CCGs are facing across England in terms of having to ration their budgets. We heard LMC reps telling us repeatedly at the GP Workforce Conference in November 2017 that CCGs only agree to new initiatives if cost savings are realised immediately. If NHS England can give CCGs the confidence to actively seek transformation in collaboration with LMCs, then they will realise cost savings in 2018/19. The knock on effects of retaining GPs in the workforce are also significant too, e.g. whole practices not handing contracts back and leaving patients without any access to primary care.
I guess the question is, who is requiring them to make savings in 2017/18? Is there flexibility that would allow them to run a deficit this year if that meant investing to save in the next financial year? I suspect there is none because much of this is ideologically driven by the government, but surely it’s in everyone’s interest to seek the greater saving, which in this case is retaining GPs and not having to train even more (at £500,000 and 10 years a pop).
Brin and Page, however, went on with the cope, as they firmly thought look
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