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Introduction to releasing capacity in general practice, a key priority for sustaining and transforming providers.

General practice is under considerable pressure right now. Recent years have seen rising volume and complexity of workload, and rising running costs, while the workforce and investment have not kept pace with other parts of the NHS.


NHS England is committed to stabilising and supporting general practice, to allow it to fulfil more of its potential at the heart of the NHS. In 2015, a study was therefore commissioned to identify the chief areas where reducing bureaucracy and reshaping demand could help practices in England. The results of the study are available at www.nhsalliance.org/making-time-in-general-practice/ 

National support

NHS England is now taking action to address the issues identified in this landmark study and reiterated by the BMA, Royal College of General Practitioners and others. 
Simon Stevens, Chief Executive of NHS England, in welcoming the increased investment being given through the GP contract in 2016/17, reaffirmed NHS England's commitment to doing more to support general practice. 
"Today's welcome agreement between NHS England and the BMA provides GPs with some stability and support, and shows what can be achieved through sensible and constructive negotiation. However this contract is only one small element of a far wider package we're jointly developing to help practices with workload, workforce and care redesign. That will require radical new options, including further support for GP recruitment and return to practice, funding for additional primary care staff, new options for practice premises, a reduction in paper-based red tape, alternative approaches to indemnity cover, and redesigned out of hours, 111 and extended hours arrangements, to name just a few - all underpinned by much greater team working across individual practices."

Local solutions

The 'Making Time' study also points to the fact that there is much GP practices can do themselves to help address their workload pressures. A growing number of practices are already making use of these, but it is clear that many are not. Practices tell us that it is often difficult to learn about promising innovations that could benefit them and their patients, or that implementing change is difficult or risky.
There is a role for NHS England in helping to spread knowledge of successful innovations and supporting practices and federations to adopt them.
Building on evidence gathered through the Making Time report and the PM's GP Access Fund, ten areas have been identified where action can be taken to release capacity in GP practices. In each area, there are several specific changes which could be implemented to make a difference. In addition to helping the practice serve its patients better through releasing staff time, many of these innovations offer a direct improvement for the patient. 

Ten high impact actions to release capacity in general practice

Crucially, this is about sharing the what practices in England are already doing to release capacity and improve care. It is not about NHS England telling practices how to organise themselves. Case studies are being collected, along with resources and activities to support local implementation. 
The ten high impact actions to release capacity in general practice
1 Active signposting: Online portal, Reception care navigation.
2 New consultation types: Phone, E-consultations, Text message, Group consultations.
3 Reduce DNAs: Easy cancellation, Appointment reminders, Patient-recording, Read-back, Report attendances, Reduce 'just in case' booking
4 Develop the team: Minor illness nurses, Practice pharmacists, Direct access therapists, Physician associates, Medical assistants, Paramedics
5 Productive work flows: Match capacity with demand, Efficient processes, Productive working environment
6 Personal productivity: Personal resilience, Computer confidence, Touch typing & speed reading
7 Collaboration with others: The productive federation, Specialists, Community pharmacy, Community services
8 Use social prescribing: Practice based navigators, External service
9 Support self care and management: Prevention, patient online, acute episodes, longterm conditions.
10 Build QI expertise.

Implementing change

No single action is a silver bullet.  Each has been found by practices to be beneficial, but we encourage people to consider multiple solutions in order to achieve the greatest benefit for themselves and their patients.
The first nine actions are 'the what' of releasing capacity - the changes practices could make. The tenth is about 'the how'. This is actually where success or failure often lies. It's also the reason why experiences of the same innovation can differ so greatly between practices. Most practices are not able to draw on the kind of leadership, service improvement and programme management capabilities that other NHS providers take for granted. 
There needs to be investment in building these, through a learn-while-doing approach, if practices are to implement this package of changes successfully and sustainably. There is a role for CCGs in investing in leadership and organisational development capabilities in local general practice, in order to achieve their sustainability and transformation goals.