Giving evidence to the House of Lords’ Integration of Primary Care and Community Care Committee, the head of the recent government commissioned review of integrated care systems and chair of the Norfolk and Waveney Integrated Care Board, repeated her review’s calls for contractual reform.
‘The GP contract is simply not fit for purpose,’ Ms Hewitt (pictured) told the committee. ‘It makes it very difficult for the many GP partners and partnership practices that really want to work in a transformational way and change the outcomes for the population they are serving. But it also makes it very difficult for small practices, possibly in very disadvantaged areas, in premises which are now in negative equity, where the partners simply cannot afford to invest in the premises, the digital systems or the staff and services that they need.’
She said that an ‘entirely different approach’ to the GP contract was needed. This needed to support and encourage those GPs who do want to continue to work as partners in traditional practices, but also those who do not want the financial responsibilities of running a business. Instead, they should be offered a rapid route into being salaried GPs.
Ms Hewitt’s review called for a national partnership group to be set up to develop a new framework for GP primary care contracts.
She also told the committee that, alongside these contractual changes, changes were also needed to the additional roles reimbursement scheme, which supports, for example, the appointment of community pharmacists within primary care networks. This has exacerbated a problem with a general shortage of pharmacists. And Ms Hewitt said the programme was ‘getting in the way of integrated care boards (ICBs) being able to manage the limited workforce they have to get the best results for patients’.
The ICB chair also repeated concerns with the mandated reduction in ICB staff. ICBs’ running costs allowance has been frozen in cash terms this year, but will be cut by 30% in real terms over the next two years – with at least a 20% reduction in 2024/25. Ms Hewitt said this reduction was ‘too large’ and ‘being imposed far too quickly’. ‘The speed and the scale of the change is undoubtedly making it more difficult to focus on what we are really here to do,’ she said, ‘which is this process of integration to get better outcomes for our residents.’
The former health secretary welcomed the publication of the recent NHS long-term workforce plan, although she said a social care plan was ‘very badly needed’. This should address workforce issues but also be part of a wider conversation about how much the public are prepared to spend on a decent quality and level of social care.
She also stressed the importance of making staff increases in the right areas to support more integrated care. She said that there had been a large increase in the NHS clinical workforce in the last four years. But she pointed out that ‘by far the largest increase’ had been in accident and emergency and other hospital consultants.
‘There has been no increase at all in the number of full-time equivalent GPs and they and their teams are doing far more work than they were doing before the pandemic and far more appointments,’ she said. ‘And, in between, we have seen an increase in the number of hospital nurses, but a lower increase in the number of community nurses. Roughly speaking that is exactly the opposite of what we need as a country and a population.’
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