Ben was CEO of Nene CCG for 8 yrs. He was a Director of an acute trust and has run national improvement programmes. He is a founding director and Principal Consultant of Ockham Healthcare, which he describes as ‘a platform for change’.
While the talk nationally is all about changing the GP contract, what do we really need to do to support the transformation of general practice? Is making funding harder and harder to access, or changing the rules around the incentive structure really going to drive the change required?
Little or no thought seems to be being given as to what is needed to support the development of general practice. If the Secretary of State wants to genuinely support real change, then this is where significant funding should be targeted.
The NHS has invested huge sums of money in recent years in developing NHS organisations. Hospitals have been supported to become foundation trusts, and for those that have not yet made it there is even now a Trust Development Authority. Clinical Commissioning Groups have been supported through the authorisation process, and have their own dedicated development team within NHS England. But virtually nothing has been invested in the development of general practice.
Practices across the country are under pressure. Workload is going up and earnings are going down. Many now recognise that they need to change, and the RCGP themselves have made it clear in their document ‘The 2022 GP’.
The problem most practices face is that either they do not know how to change or they do not have the capacity to change. The busier the practice becomes, the harder it is to release GP partners or indeed anyone to understand and drive the process of change.
We are currently relying on a small number of exceptional individuals who are making change happen in pockets around the country. But they are doing this despite the system not because of it. The NHS needs to be making it easy for practices to change, and be actively providing support.
So where should organisational development support for general practice come from? The Area Teams of NHS England certainly do not have the capacity to do it. CCGs in some areas are starting to take this on, but are risking all sorts of accusations of conflicts of interest in doing so. And is it really sensible to replicate the development of support 212 times?
The best way for support to be delivered would be through a national General Practice Development Agency. The role of such a body would be to support large numbers of practices to change, so that both the practices have financially sustainable futures and that practices are able to play their role in enabling local health economies to become financially sustainable.
This agency would need to have the funding to support practices to change. It would develop and make available the tools for change, and more importantly create a visibility of the change. It would accelerate learning, share best practice, and provide tangible support to those that need it.
The big objection to this comes from the fact that GP practices are independent businesses. So essentially there are two problems: first why should the NHS support non-statutory bodies; and second what jurisdiction could any such agency have over independent practices?
GP practices are funded by NHS money, provide NHS services, and are a recognised cornerstone of the NHS. Using public money to provide development support to GP practices would pass the Daily Mail test. So the first objection is theoretical rather than real.
The second is equally easily overcome. The problem a national agency with funds and resources for practices will have is complaints about the speed and ease with which practices can access these resources, not whether they will want to in the first place. I am not suggesting we set up a GP equivalent of the TDA, with a directive and imposing style. What I am proposing is a dedicated agency whose role is to support and accelerate the changes that many practices already want to make.
We need a General Practice Development Agency. We need support for practices to change that is effective, coordinated and resourced. And we need it now.
This article was first published on September 14th, 2013 on www.ccginformation.com
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