Transformation or impending disaster? New models of primary care in NW London

We just don’t know the answer to the question in our title, but we need to find out a lot more. After all GPs are our gateway to the NHS and according to the last estimate in 2013 there were some 340 million consultations annually.

It is now clear that there is a top-down national major re-organisation of GP and other primary care NHS health services afoot that the public have been told very little about. Whether the public or GPs will stomach it when they find out what is going on is an open question. One wonders if Mr Cameron and Mr Hunt have thought about the politics?

This project is central to the October 2014 NHS ‘Five year forward view’ paper produced by the new NHS Chief Executive Simon Stevens and seemingly swallowed whole by Ministers. It is also ordained by the current Strategic Commissioning Framework (SCF) if you know what that is.

The best clue yet to what is happening in our neck of the woods is provided by paper (2a) for a 4 February 2016 meeting of the NW London NHS Primary Care Co-commissioning Joint Committees in Common (sic) . For anyone bemused by this extraordinary mouthful it means that each of the 8 NW London CCGs has a joint primary care co-commissioning committee with NHS England and on this occasion all 8 met together (hence “in common”). The meeting was at the NHS England (London) office in Marylebone and was open to the public, including a member of BPV. At the previous meeting on 17 September Brent Clinical Commissioning Group was represented by their chair Doctor Ethie Kong and Chief Executive Rob Larkman.

The September minutes make salutary reading. Many doubts were expressed about the realism of the project. The Healthwatch representative pointed out that the public does not have a clue as to what is going on. In spite of these doubts Jo Ohlson, the former Chief Operations Officer of Brent CCG, now Director of Commissioning and Operations NW London with NHS England, firmly reminded the committee that this is a national project with an inflexible timetable that must not be delayed.

Section 6 of the 4 Feb paper envisages a national scheme to establish primary care services contracted through large federations of GP practices on scales of between 3 and 102 practices (mean 32) with 1,000 to 796,000 patients (mean 170,000). Note that the largest practice in Brent currently has just over 14,000 patients. It is not clear how these new federations may differ from the four Brent locality GP networks with their NHS ‘provider’ status. On a map Brent is shown as having four federations, which hitherto we have known as the 4 networks (i.e. limited companies of practices which can tender for NHS community services). Elsewhere a federation seems to cover a whole borough.

The new scheme also involves ‘Accountable Care Providers’ which we know from Whole Systems Integrated Care presentations means a consortium comprised of GP networks, hospital trusts and others. It is difficult to understand exactly what is proposed as the project is clouded in typically obscure or misleading project names and euphemisms. We have serious doubts as to whether local GPs have grasped what all this might mean, not least in relation to the traditional GP/patient relationship.

The financial data reveals that all the CCGs involved have current overspends projected to total £1.8 million for the present financial year.

There is no reference to how this scheme is to be coordinated with the new London Devolution of NHS/local authorities social services. A kind view might be because its 15 December 2015 announcement by the Chancellor George Osborne was too late for the work in progress on the papers for this meeting. Less kindly we might think that there is no connection since the right hand and the left hand are not too closely in touch.

All these big schemes appear mostly to continue the bureaucrats’ game of musical chairs. There is still no mention of the NHS’s statutory duty to involve the public in this major upheaval. At the patient interface little has changed since Brent CCG came into being on 1 April 2013.

BPV asked Brent CCG to hold a public meeting to explain to the people of Brent what this initiative really means and why it is described as a “transformation” when what most patients want is an appointment with a named GP as soon as reasonably practical. Regrettably the CCG’s response was a brush off. They promised to include material in a paper for the Brent Health & Wellbeing Board  on 22 March 2016.

Discussion on this occasion was confused. Brent Council’s CE, Carolyn Downs, indicated that she could not understand what the paper was getting at. Dr Ethie Kong, Chair of the CCG, said that she and her patients wanted to maintain the traditional GP/patient relationship, seemingly unaware that the paper from her own organisation, was proposing the exact opposite. A CCG staffer, seconded from PA Consulting to the CCG, said it was time to put an end to the cottage industry provided by current GP arrangements and that patients should just be told what they needed to know. At this point BPV observers in the meeting nearly fell off their chairs.  BPV had already asked for the Brent Council Scrutiny Committee, which can hold the local NHS to account, to take up the issue.  Cllr Matt Kelcher, Chair, has promised to put it on the agenda of the new Health Scrutiny Committeee which is to begin work after May.

Robin Sharp, Interim Chair Brent Patient Voice with much help from my colleagues

revised 24 March 2016




8 February 2016

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