Supporting London GPs under pressure
Meeting the needs of a growing and changing capital city can be challenging for GPs. We examine those challenges in two practices and look at the support available through the General Practice Resilience Programme.
90% of all patient contact with the NHS happens in primary care. This results in 360 million consultations each year across England, and 60 million here in London.
GPs do a fantastic job in rising to the challenges of supporting the healthcare needs of a growing and changing capital city. But workload pressures are a concern for a number of practices in London.
Here we consider those challenges in two practices, and look at the support available to them through the General Practice Resilience Programme.
Rising workload was identified in the 2015 British Medical Association (BMA) survey as the single biggest issue of concern to GPs and their staff in England. As a result, the General Practice Forward View, published in April 2016, announced that the General Practice Resilience Programme would provide £40 million in funding to support and stabilise practices.
The purpose of the fund is to deliver a wide menu of support that will help practices to become more sustainable and resilient; better placed to tackle the challenges they face now and in the future; and more able to provide continuing high quality care for patients.
In London, we have initiated and developed these programmes at a Clinical Commissioning Group (CCG) level.
This means that GP practices and their staff can influence local programmes to ensure they meet their individual and collective needs and challenges.
This year, we’re investing around £4m in the General Practice Resilience Programme — offering support to 321 individual practices and 44 groups of practices. We expect more practices to take up offers of support as the programme continues over the next two — three years.
Broadwater Farm Health Centre’s story
Broadwater Farm Health Centre provides GP services in the Broadwater Farm housing estate in North Tottenham, London.
Although it is now part of a group of practices which work together to provide primary care services in Haringey, Broadwater Farm Health Centre was previously a ‘single-handed’ practice — the term used for GPs which operate alone from their premises and not in partnership with other GPs.
The practice is based in a purpose built health centre on the Broadwater Farm housing estate. The estate has a population of around 4–5000 people, and the practice treats about 3000 people. There are some significant economic, social and health challenges.
Broadwater Farm Health Centre is run by the Lawrence House Surgery which provides services at three other surgeries in North East Haringey. Each of the surgeries are in areas with challenges, but GPs at Broadwater Farm reported that they felt that the workload at this practice was particularly challenging. GPs reported that a high number of patients require advocacy and suffer from multiple health conditions and social care issues, which require additional intensive, targeted support from practice staff.
Although the Health Centre was an early instigator of GP First (a telephone consultation instead of a face to face appointment where appropriate) and other initiatives designed to help manage workload, the GPs at Broadwater Farm do not feel that these schemes have been effective in supporting them to meet the challenges of this practice. Recruitment and retention of staff is also very difficult in all practice roles.
Investment from the Practice Resilience Programme as well as other funding made available in the General Practice Forward View (totalling £28,000) was offered as part of a long-term package of support to the practice. The later will inform commissioning intentions and a new model of delivery of this type of atypical practice.
As a result of this investment, the practice has developed a comprehensive understanding of patient need as well as a new service specification that addresses the demand and need in this type of atypical practice. The practice has also developed a new model for recruitment.
Friends Road Medical Practice’s story
Friends Road Medical Practice provides GP services in Croydon, South London.
In the past two or three years, the practice began to struggle with its registered patient list and significant workforce challenges. Eventually, it considered formally closing its list to new patients. The practice felt it had been under pressure for some time for a number of reasons including a rising local population, issues with recruitment, and subsequent reliance on locum doctors.
In order to help support and stabilise Friends Road, the practice received just over £40,000 of funding from the General Practice Resilience Programme. A proportion of the funds will be contributed towards the excess cost of locum sessions in order to increase the number of appointments and meet the needs of existing registered patients, as well as new patients joining the practice.
The funding is also being used to increase the existing nursing provision to approximately 52 hours, which is an increase of 16 hours per week. This will enable the practice to provide additional and a more appropriate number of appointments, which are particularly needed for new patient registrations and the provision of ongoing clinical care.
In addition, the funding is helping increase the number of reception hours by 16–20 hours per week and the secretarial hours by 4 hours per week to cope with the additional administrative functions associated with a rising population.
As a result of this support, the practice list has been kept open. The staffing support is giving the practice the time needed to re-advertise for a salaried GP with an aim to have a GP in post as soon possible. In the short term, additional locums will be engaged to meet the continued growth and to increase capacity.
In addition to increased GP time, the practice has greater capacity to explore different models of care to meet the needs of the growing population. Increasing the nursing hours and those of the reception and the admin team has added to the resilience of the practice and their capacity to grow in an effective and safe environment.