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What the NHS long term plan means for general practice

9 January 2019

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The NHS long term plan, published this week, placed a stronger focus than ever before on investing in primary care and community health services.
 
Under the plan, the two sectors will receive a significant funding boost by 2023-24, which will be used to reduce demand pressures, expand the workforce and create new services.
 
The plan was requested by prime minister Theresa May last July, when she announced extra funding to mark the health service’s 70th birthday. It sets out how services will be delivered over the next decade. Here are 10 things you need to know about changes to general practice:
 
1. Primary and community care services get a bigger chunk of the NHS budget
 
Primary and community care services will get a £4.5bn funding boost by 2023-24 as part of the long term plan. The plan states that: ‘this is the first time in the history of the NHS that real terms funding for primary and community health services is guaranteed to grow faster than the rising NHS budget overall’.
 
2. All GP practices have to join a primary care network
 
The long term plan confirms the Government’s commitment to primary care networks and all individual GP practices in a local area will now have to enter into a network contract.
 
The network contract will be an extension of practices’ current contracts and there will be a designated single fund for all network resources. Local contracts for enhanced services will normally be added to the network contract, the plan outlines.
 
The networks are based on GP registered lists and typically cover 30-50,000 patients.
 
3. Community multidisciplinary teams will be expanded
 
The £4.5bn investment will be used to expand community multidisciplinary teams, which will work alongside the new primary care networks, the long-term plan says. The teams will comprise of range of professionals; from pharmacists, GPs and district nurses, to dementia workers, community geriatricians and allied health professionals such as physiotherapists.
 
4. NHS 111 will be able to book appointments directly with GPs
 
In 2019, the NHS 111 service will start direct booking into GP practices across the country, as well as refer people on to community pharmacies who promote patient self-care and self-management and can support with urgent care. Clinical Commissioning Groups will also develop pharmacy connection schemes for patients who don’t need primary care services.
 
5. Primary care networks will have access to a ‘shared savings’ scheme
 
The ‘shared savings’ scheme will enable primary care networks to benefit from actions to reduce avoidable A&E attendance, admissions and delayed discharges, as well as reductions to avoidable outpatient visits and over-medication through pharmacist reviews, the plan says.
 
6. There will be significant changes to the QOF framework 
 
To support the new ways of working there will be changes to the QOF framework, the plan says. This will include a new quality improvement element, which is being developed jointly by the RCGP, NICE, and The Health Foundation. The least effective indicators will be retired; with the revised framework will support more personalised care.
 
7. GP vaccination and immunisation standards will be reviewed
 
The plan says there will be a ‘fundamental review’ of GP vaccination and immunisation standards, funding and procurement in 2019. This is designed to help improve immunisation coverage, using local coordinators to target variation and areas where vaccine uptake is low.
 
8. The enhanced health in care homes model to be rolled out nationally 
 
NHS England’s enhanced health in care homes (EHCH) vanguards have improved services and outcomes for people living in care homes, the plan states, and so as staffing and funding grows, the model will be rolled out across the country over the next decade.
 
The plan says this will ensure ‘stronger links’ between primary care networks and their local care homes, with all care homes supported by a team of healthcare professional, including named GP support.
 
Primary care networks will also work with emergency services to provide emergency and out-of-hours support to care homes.
 
9. More social prescribing and more personal health budgets
 
The plan pledges that by 2023-24, 2.5 million more people will benefit from social prescribing, a personal health budget and new support for managing their own health in partnership with patient groups and the voluntary sector.
 
This will be achieved by rolling out the NHS personalised care model, which is currently being implemented across a third of England, to all areas. As part of this, social prescribing link workers will be based within primary care networks to develop tailored plans and connect people to local support groups.
 
10. Digital-first primary care to become a new option for every patient
 
Over the next five years, every patient in England will have a new right to choose a telephone or online consultation with a GP – usually through their own practice. However, if they prefer, it could also be from one of the new digital GP providers, the plan says.
 
This new commitment will be delivered in a three-pronged approach, the plan states.
 
The elements of this will will be: to ensure that digital-first practices are safe and beneficial to the whole of the NHS; to create a new framework for digital suppliers to offer their platforms to primary care networks on standard NHS terms; and review GP regulation and terms and conditions in order to better support their return to practice and increase participation rates by GPs wanting to work in this way.