Agenda item

Stephen Ingram (Head of Primary Care, NHS England South (South East)) and Dr John Allingham (Medical Secretary, Kent LMC) were in attendance for this item.

(1)          The Chairman welcomed the guests to the meeting.  Mr Ingram began by highlighting recent national strategy and policy developments. He stated that general practice remained seriously challenged and the level of change had continued to accelerate.

(2)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about practice mergers. Mr Ingram explained that practices submitted merger proposals to NHS England for consideration and processing. NHS England discussed the merger in consultation with the Kent LMC and relevant CCG to ensure that the merger was sustainable, resilient and achieved a greater critical mass. He noted that whilst it was possible to merge existing contracts under the General Medical Services (GMS) and Personal Medical Services (PMS) agreements, it was not possible to merge under the AMS contract. He explained that whilst the decision ultimately lay with the contract holder, NHS England were able to make suggestions to practices about potential mergers. Dr Allingham stated that the Kent LMC supported practices during mergers and the surrendering of contracts to other providers. He noted that there were still a number of single GP practises in Kent. The Kent LMC encouraged practices to collaborate in order to work at scale and improve resilience. He reported that the CQC could place a practice in special measures and recommend that another provider takes over the service.

(3)       In response to a specific question about housing growth, Mr Ingram explained that NHS England was involved in the housing developments at Ebbsfleet and Chilmington Green Ashford. He stated it was important for a practice to be established early, in order for new patients to register. The practices, including the patient list and workforce, should expand as the community grows. He noted that in Broadstairs, a practice’s patient list recently increased from 2000 to 5000 following the closure of an existing practice.

(4)       Members enquired about the recruitment and retention of GPs. Mr Ingram highlighted the publication of The New Deal for General Practice – GP Workforce 10 Point Plan which set out initiatives to recruit newly trained doctors into general practice, retain GPs and encourage doctors to return to general practice. Dr Allingham stated that general practice was struggling with recruitment and retention. He highlighted barriers to retention included a loss of seniority pay, changes to the pension scheme and GPs reaching their pension lifetime limit early. He reminded the Committee of a case study he had previously bought to their attention regarding a GP who had faced difficulties returning to general practice after a period of absence. He stated that he was currently helping a European GP to retrain in order to practice in the UK. He noted that since April funding had become available to pay the practice providing the training and the European doctor during their training.

(5)       A number of comments were made about workforce in coastal areas, sole practitioners in urban areas and prescription and referral powers. Dr Allingham explained that it was difficult to attract the workforce to coastal areas. Many young doctors who trained in Kent had aspirations to return to London. He noted that 36% of GPs in Kent were over the age of 50. Mr Ingram explained that other coastal areas in Essex, Norfolk and West Sussex had similar recruitment problems. Mr Ingram reported that there were a number of sole practitioners in Medway, Dartford and Gravesham. He stated that NHS England’s role was to ensure those practices were not left behind in delivering services to the required standard. NHS England’s levellers were to encourage and support small practices to reconfigure themselves and become more resilient. Mr Ingram noted that in certain circumstances nurse practitioners were able to prescribe and refer patients. He stated that in the future nurse consultants would be able to independently prescribe allowing GPs to spend more time on complex consultations.

(6)       RESOLVED that the report be noted and that NHS England be invited to attend the June 2016 meeting of the Committee.