Practice managers and GPs must “suspend their cynicism” about the Forward View if it is going to work, according to the lead on primary care at NHS England.
Speaking at Management in Practice London, NHS England’s national director of primary care, Dr Arvind Madan told the audience he understood “the cynicism” behind the Forward View which includes an extra £2.4bn a year for general practice from 2020, but there was “no plan B”.
“I shared the cynicism and that’s why I got involved,” he said. “It’s pretty easy to throw rocks at this stuff but we don’t have a plan B so why don’t we get behind it and see if we can do it?
“I would say, if you can, suspend your cynicism for a little while and give this a chance to breathe and see if it’s starting to make a difference.
“The worst case scenario here is if this could have been a viable solution for the system but the cynicism stopped general practice from holding its hand out to take the option.”
Dr Madan, who was the key note speaker at the conference, said that “the penny had dropped” across the NHS that a “strong general practice” was essential for the sustainability of the wider health service.
“We’ve had a decade of underinvestment. A third of GPs are ready to leave in the next five years – if you look at GPs over the age of 50 that jumps to almost two-thirds. Morale is at its lowest level since records began in 2001. This is a really difficult backdrop in which to implement change,” he said.
“Firstly we need to stabilise the existing situation of practices handing back their contracts. Secondly, we need to transform general practice in a way that takes the benefits of some of the other moving parts that are now currently available to us.
“We possibly don’t have the opportunity to go back to a previous era of what general practice used to look like but we do have the opportunity to leap-frog using what we might do with self-care, with skill mix, with technology, how we might work at scale – different ways of doing things,” he said. “So that we can leap-frog a few evolutionary steps into a new version of general practice once the situation is more stable.”
“We have won the debate internally with the DH and NHS England to start investing significant sums into general practice services,” Dr Madan said.
From 2020 onwards there will be an extra £2.4bn a year for general practice services. This will mean a 25% cash increase and a 14% real-terms increase above inflation.
“We shouldn’t underestimate in a climate of austerity, when social services are under significant pressure, what a vote of confidence in general practice that represents,” he said.
“The ambition here is that we don’t just stop at what comes from central funding from NHS England but actually we start to accelerate the investment that already happens to the tune of about £1.8bn a year from CCGs into general practice services as they move care closer to home.”
Of the £6m investment for practice manager development, Dr Madan said that over the next four years the new support will include expanding the national network and encouraging professional development as part of the three year £30m national development programme.
Chair of the session, Stevens Williams, who is also co-chair of the Practice Management Network (PMN) closed the conference by saying: “The amount of money that has actually been invested into practice management is a paltry sum. It is not going to go far. On average it works out to about £700 per practice manager. So what [PMN] wants to do is continue the debate. NHS England has kindly opened the door so we on your behalf will represent you but we need to pull together to actually do it.”
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