Copyright 2019 - Clinical Commissioning Groups Association

Helping Struggling GPs - Dr Michael Heber FRCGP

The RCGP Practice Support Programme was set up in 2015, with the specific aim of supporting struggling practices. The GP Forward View recognised that throughout the country GPs and their practices were coming under increasing pressure through rising workload, increasing and more complex demand, static or falling income and difficulties with recruitment. The Care Quality Commission (CQC) had also begun their inspection regime and had started placing a minority of practices in Special Measures – basically a threat of closure unless strictly defined criteria for improvement were met. The RCGP Special Measures Programme was set up and commissioned by NHS England (NHSE) to provide peer support and advice, and has since evolved into the Practice Support Programme as it has enlarged its remit to supporting and promoting resilience on a wider scale. Closure of a practice can be personally devastating to its GPs, staff and patients, hugely costly to both individual GPs and the local health economy – aside from leaving thousands of patients without a GP as has recently happened in Folkestone. The programme has been demonstrably effective at helping to prevent this happening.

The programme was initially funded by NHSE at a rate of up to £10,000 per practice. A methodology was devised and evolved. All practices put into Special Measures were referred to the RCGP unit, and offered support, although not all accepted it. After initial conversations with the practice a “Scoping” process was started involving communication with the CQC, CCG and Stakeholders, and a practice visit by a Clinical Adviser (usually a GP, sometimes a Nurse) and Practice Manager Adviser. The scoping visit involves in depth interviews with as many staff members as possible, and looking at specific areas where the practice maybe struggling for example leadership, management, finance, or protocols and procedures. A scoping or diagnostic report is then written and shared with the practice, and an improvement or turnaround plan created. Specific and “hands on” support is offered to the practice to achieve the objectives. Referral to local sources of support, such as the CCG, is made where available and appropriate. Evaluation of the support is also rigorous.

Our experience has been that the RCGP “brand” has led to us being welcomed into practices where we have generally been seen as critical friends rather than yet another group of inspectors or outsiders telling practices what they must do without offering practical support. Common themes identified have been workforce capacity, finance, premises, leadership and organisation, weak management, communication and professional isolation.

To date the Special Measures Programme has been referred a total of 200 Practices. 143 have accepted support, and 93 have completed the process. Of the practices that have been re-inspected 80% have successfully exited Special Measures, which suggests that the intervention is effective. We have learned that success is built on early identification of root causes, development of a good relationship with the practice, early production of an action plan, addressing quick wins and optimism on both sides. We have observed that unsurprisingly reluctance to engage with support is associated with poorer outcomes.

With a view to the future the Practice Support Programme is looking at supporting resilience in practices with specifically tailored support, as either commissioned by the referring primary care organisation or as requested by practices who may refer themselves. We believe that the experience we have developed in Special Measures Support will enable us to offer unique and high quality interventions that are perhaps not readily available from other providers or sources.

Content provided by Dr Michael Heber FRCGP

GP Cobtree Medical Practice, Sutton Valence, Kent

Clinical Adviser, RCGP Practice Support Programme
Royal College of General Practitioners
30 Euston Square, London, NW1 2FB

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