GP funding crisis update

Update 7th October. Practices are now having their special case applications considered by the CCG. Some practices with income loss have chosen to explore other solutions like mergers. The CCG is to become a Level 3 co-commissioner of primary care with NHS England which means that once again (as in the Sheffield Primary Care Trust abolished by the Coalition) commissioning decisions for Sheffield will be taken in Sheffield - though GPs are excluded from the actual decision making.

July 2015 A packed public meeting of the CCG goverening body on 16th July heard almost an hour of representations from the public, a presentation from the CCG and statements from NHS England, the Local Medical Committee and GP representatives of the four Sheffield localities. The CCG stated that the 11 practices most at risk were from different and differing areas of the city, not just disadvantaged areas but support for Devonshire Green and Page Hall was explicit, including from other GPS who supported the general principle of equalisation. In the end Members of the Board eligible to vote agreed the original proposal but with an apparently enhanced safety net (in terms of criteria rather than money)giving more weight to health inequalities, a commitment that no practice would be left unviable and an agreement to report back in public during September.

The CCG's relief was understandable. They took the risk of holding a complicated decision making meeting in public, they gave space to the public to voice their feelings, they gained a lot of useful feedback and they got their original recommendation through. Campaigners (especially the two practices most at risk) were also successful in getting very strong shows of patient support particularly from migrant communities which are not often heard, let alone seen at public meetings.

However for the most vulnerable practices the relief must have been more double edged. They could feel both pleased and relieved at some of the assurances given, but were also alarmed that little or no additional resources were being made available and that they would have to spend a considerable amount more time and effort to make very strong cases to prevent actual cuts in practice income and therefore services. The only disadvantage weighting used for the equalisation proposal has been the inadequate modified Carr-Hill formula from 2004 which does not include ethnicity or language and the new safety net measure have to recognise that this will not do and the CCG must be pushed to recognise the particular problems of serving transient populations where the list/per capita model of financing does not reflect patient demand. Development of these arguments, particularly from Devonshire Green, has been going on for a long time; NHS England and the CCG have no excuse for not producing appropriate, effective, fair and acceptable solutions. Some services will probably have to be shared with / co-delivered by neighbouring practices and as with most NHS reconfigurations, however justified, these changes may affect jobs, earnings and livelihoods as well as services.

Overall and not surprisingly GPs were overwhelmingly in favour of the equalisation policy especially now that collaboration and integration are being given a bit more emphasis than competition. All practices feel stretched and from a business point of view equalisation now makes more sense. This probably reflects the uneven development of PMS contracts where nationally some practices working with disadvantaged populations have sought to maximise the resources they can bring to meeting their health needs, but others have involved GPs finding ways of increasing their practice income without increasing services. The historical anomalies surrounding contracts have resulted in situations where neighbouring surgeries serving similar populations (including disadvantaged ones or communities with special needs) receive considerable different incomes. Interestingly the promotion of PMS income opportunities by Labour in the 2000s could be seen as reflecting Labour's belief at that time in competition and choice: unequal resources mattered less because they promoted competition between GPs which therefore increased patient choice. This is yet another of the ways in which Blairite Labour laid the foundations for Andrew Lansley.

SSONHS has actively offered support to the surgeries under threat and has received formal thanks from them. If progress on the safety net for practices is not clearly being made by September the next Business Meeting of the CCG on September 3rd and the CCG AGM on September 10th will have to be lobbied even more strongly.