2024 RCGP annual conference and Labour’s plans for the NHS
Medical Defense Society was pleased to sponsor and attend the Royal College of General Practitioners (RCGP) Annual Conference and Exhibition 2024 on 3–4 October at the ACC Liverpool. We heard from Wes Streeting, who addressed delegates in a keynote speech – the first secretary of state to do so in seven years.
He acknowledged the difficulties experienced by GPs in managing ‘increasingly complex care’ without the resources, infrastructure and authority required, saying: ‘Patients are frustrated they can’t see you. You’re frustrated you can’t meet their demands.’
His remarks reflect the findings of the Independent Investigation of the NHS in England, published on 12 September. Led by surgeon and former health minister, Professor Lord Darzi, the review was commissioned by the government to assess the current state of the NHS.
The Darzi review: NHS in ‘serious trouble’
In agreement with Mr Streeting, who declared the NHS was ‘broken’ on his first day as Secretary of State for Health and Social Care, Darzi found the NHS to be in a ‘critical condition’.
He said that while NHS staff are ‘doing their best to cope with the enormous challenges’, patient satisfaction has been eroded by increasingly long waiting times across the NHS, for GP services, surgery, cancer care, A&E, and mental health services.
He concluded that key drivers of the deteriorating service were: austerity in funding; the pandemic; lack of patient voice and staff engagement; and management structures and systems. In addition, the 25% cut in public health grants to local authorities since 2015 contributed to the worsening state of the nation’s physical and mental health, causing surging demand for NHS services.
Darzi judged that NHS money is not being spent where it should be: less should be spent in hospitals while community services should receive a greater share. In hospitals, staff numbers rose by 17% between 2019 and 2023. Meanwhile, in primary care, although GPs now see more patients than ever, the number of fully qualified GPs is falling and patients are struggling to get appointments.
Wes Streeting’s plans for general practice
The findings from the Darzi review will now inform the ten-year health plan that is expected in spring 2025. At the RCGP annual conference, Mr Streeting explained that the plan will shift the focus of healthcare in three ways – “from hospital to community, analog to digital and sickness to prevention”, with general practice playing a core role.
Reinforcing Labour’s commitment to improving continuity of care, he said: ‘it will be at the heart of this government’s plan to reimagine the NHS as much as a neighbourhood health service as a national health service.’
He also promised to ’bulldoze bureaucracy’ in general practice. This will include avoiding unnecessary GP appointments for referrals. He cited the example of a pilot to directly refer women with a worrying lump to a breast clinic via 111 Online, starting from November.
What is needed to ‘fix’ the NHS?
The Darzi review strengthened the case for radical reforms in the NHS. Labour now has the responsibility for trying to fix the problems, and GPs must await details of how the government plans to do this. While Mr Streeting committed at the conference to ‘growing the proportion of the NHS budget that goes into primary care’, he cautioned: ‘I can’t turn around 14 years of underinvestment in a single budget or even a single spending review, but we can start to move in the right direction.’
Siva Anandaciva, Chief Analyst at The King’s Fund, said: ‘There have been some reports that the NHS will be at the centre of the upcoming Budget, but against a backdrop of constrained public finances, the proof will be in the pudding of how far the government is willing to go to support health and care services ahead of next year’s multi-year spending review.’
Of note, the British Medical Association (BMA) has proposed terms for negotiations on future contract reform. The ‘heads of terms’ document is published as part of the BMA’s ‘Patients first’ vision for general practice, intended to be a ‘framework for future negotiations’ in line with Labour’s manifesto commitments and the Darzi review.
The aim is for a major new contract to be implemented by April 2028, aiming to fully resource general practice, enable continuity of care, and rebuild the workforce.
‘Stand down collective action’
Mr Streeting emphasized the need for government and GPs to work together and called on GPs to ‘stand down collective action’ as it would ‘punish patients’ and hinder recovery.
He wrapped up his speech by urging, ‘I need every part of the NHS to pull together as one team, with one purpose. To be the generation that took the NHS from the worst crisis in its history, got it back on its feet, and made it fit for the future. That’s the mission of this government, and I’m confident that together we will rise to it.’
However, in response, GP leaders in the BMA reiterated that general practice must take action to limit the unsustainable pressure. They called for an increase in core general practice funding from 2025/26 as a first step towards ending collective action.
Other news from the RCGP conference
Additional roles reimbursement scheme (ARRS) funding for GP jobs to continue beyond March:
An emergency fund of £82m is now available through the ARRS to enable recruitment of newly qualified GPs in 2024/25, from 1 October 2024 to the end of March 2025.
Following RCGP calls for a ‘public commitment’ that these jobs would not end in March, the college chair, Professor Kamila Hawthorne, questioned Wes Streeting on this point at the conference. He responded with a promise that the funding would continue beyond March, saying ‘that’s the kind of stability and the certainty that people need now, both in terms of employing people, but also taking up jobs.’
Despite this promise, GPs remain concerned that ARRS funding for GP roles is insufficient. There is also dismay that the overall ARRS budget uplift this year is limited to 2%, meaning that primary care networks may struggle to afford the 5.5% pay rise awarded to ARRS staff from 1 October.
Single register of GPs and specialist doctors:
For years, the RCGP has been calling for the GP and specialist registers to be merged into a single register, to give GPs ‘parity of esteem’ within the NHS and formally recognise their expertise.
Mr Streeting confirmed at the conference that he is ‘committed to the creation of a single register of GPs and specialist doctors, and this government will legislate to give the GMC the power to do it.’ He added, ‘It’s symbolic, but it’s also meaningful. It reflects the partnership I want to build with this profession.’
New RCGP guidance on Physician Associates (PAs) roles: Induction, preceptorship, supervision and scope
Since the RCGP conference, the college has published new guidance on PA roles in general practice, setting a ‘deliberately narrow’ scope of practice to maintain patient safety and reflecting the limited evidence base.
- Induction, preceptorship, and supervision: The guidance includes that all PAs should have a minimum induction period of two weeks, full-time equivalent when they begin a new role. Furthermore, each PA must have a named GP clinical supervisor and, during a ‘preceptorship period’ – normally 12 months – also a GP educational supervisor.
- Scope: The guidance states that ‘PAs must not see patients who have not been triaged by a GP and only undertake work delegated to them by, and agreed with, their GP clinical supervisor.’ It also provides a list of patients who should not be seen by PAs, including those with potentially serious or complex conditions.
While PAs can take a history, complete a physical examination, and construct an appropriate diagnostic and management plan, they must share the plan with their GP supervisor. There are also strict limits on the PAs’ role with regards to clinical procedures, tests, prescriptions, and patient forms.
- Employers are responsible: Importantly, although RCGP cannot enforce the rules, employers are responsible for the appropriate handling of PA contracts, and the guidance may be ‘taken into account by NHS Resolution and medical defence organisations in a case of alleged negligence or clinical or professional mistakes’. Employers must ensure that adequate professional indemnity insurance is in place for the PA.
Reports of Care Quality Commission (CQC) failings
Finally, Medical Defense Society members who rely on CQC registration will no doubt be interested in the reported failings of the organisation. The full report by Dr Penelope Dash has now been published, and will be the focus of our next article in November.
If you would like advice about any of the topics discussed here – including collective action, ARRS funding, PA roles, and CQC inspections – please get in touch at Medical Defense Society.
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