Mword 31 - We have your backs

1 December 2016

Dear Colleague,

At our Londonwide LMCs’ annual conference in April we declared a GP State of Emergency in London. I don’t need to rehearse the reasons why, save to say that much of what the rest of the country’s GPs are now waking up to is what we have been struggling with in London for a considerable time. We have, as I hope you will have noticed, made MUCH noise on behalf of London’s GPs and practice teams. Some of that noise has also been focused on our national bodies such as the BMA’s GPC and the RCGP, as they push government to address the financial, workforce and workload challenges that are crippling the profession within a heavily politicised environment.

Against all of that and a backdrop of enforced MPIG reductions and successive unworkable London Offers (see PMS Bulletin 9) we have been actively pushing our policy of Stabilise and Sustain for Long Term General Practice in London out to the London NHS and Mayoral systems. Our Framework: Health and Wellbeing for London’s People has been fundamental to this approach.

The above - along with recognition of the need to ensure fairness, stability and sustainability for both GMS and PMS practices in the rapidly and ever-changing landscape within the NHS; CCGs aligning across STP footprints; financial imperatives; delegated commissioning; the government’s PMS Review; the stop-start complexities of implementing the government’s GP Forward View; and practice closures - has led the London NHS system to accept and promote the fact that London’s general practice is the cornerstone of the NHS, and must be stabilised and sustained for the long term.

Brexit, Trump and the supermoon may also have played their part in this epiphany. Whatever. The outcome is that Londonwide LMCs regionally, and LMCs locally, will play a key city-wide role in assurance of GP funds, primary care and the impact of London's system decisions at local, STP and pan-London levels. This ‘triple lock’ means that:

1. Local contracting decisions will be subject to a London single standard operating framework agreed between Londonwide LMCs and NHS England London. Remember it is NHS England London that holds CCGs and STPs to account through its assurance process to NHSE, and it is NHS England London that has agreed this approach with us and has made its implementation a key expectation of its CCGs and STPs. This should enable us to assure delegated CCG, STP and NHS England decisions through a transparent governance process in keeping with the purpose of the letter – to Stabilise, Sustain and Transform for Long Term General Practice in London.
   
   
2. The PMS Review will be subject to the same assurance process outlined above (PMS Bulletin 10 (available 2 December) will outline further details).
   
   
3. As will the GP Forward View and other funding streams.

Through this mechanism we will assure that the core values and tenets of general practice within the Capital underpin decision-making across London’s NHS system – CCGs, STPs and NHSE London. In September’s Mword 30, I said:

“we have to survive this current chaos with even more determination than all the other waves of chaos. So if transform we must, then let us not do it at the expense of our values, or compassion for ourselves. Let it be a transformation in our own image and not the image of those who this far still just. don't. get. it.”

Well, as illustrated in a joint letter to CCGs from myself and Anne Rainsberry, Regional Director of NHS England London, it appears on the back of their new approach that they. now. do. And that they are now prepared to collaborate with us to provide the assurance that they do. Should you wish to see the letter, please contact my office.

And so we believe this approach now provides all parties with a fresh platform to help build trust, and to ensure that the PMS premium, GPFV, and other funds are invested in the fairest and best way to stabilise local practices and support longer term sustainability in the new STP-dominated environment. Against the odds we may, for the first time in over a decade in London, be seeing some light at the end of one of many tunnels. Our job is to help you keep your vision to get to the end of all of them.

You have the eyes... and we have your backs.

Best wishes,

Michelle
Chief Executive, Londonwide LMCs

As ever - Please do let me have any views on these issues or others at mword@lmc.org.uk.