Dr Michael Dixon, who is NHS England’s clinical champion for social prescribing, has suggested that the extra funding would provide GPs with the means to employ an adviser, who could provide patients with a “solution that is not medicine or a procedure”.

According to Dr Dixon, who employs a social prescribing adviser in his own practice in Devon, social prescribing works and is very important for general practice, as, where it works well, it reduces pressure on GPs. What’s more, he argues, at £1 per patient, it is a “tiny amount” and would be funded by the Clinical Commissioning Group (CCG).

He added that GPs should be able to access advisers in several ways, including a ‘practice-attached’ adviser who is paid for by the CCG or a ‘hub and spoke’ system for smaller practices where advisers go out to visit practices.

However, critics of social prescribing are doubtful of its effectiveness, with one saying that there is little supporting evidence that it works. A review published by York University last year concluded that only a few studies had advocated its use and all were of “poor quality”.

Meanwhile, another study carried out in East London found that referred patients had much higher consultation rates and actually used more prescription medications before referrals than controls.

NHS England, which included social prescribing in its ‘10 High Impact Actions’, said it was not aware of any current work to progress funding allocation for social prescribing.

The fund was a key part of the ‘new deal’ for GPs when it was announced back in 2015, but in the intervening 18 months only £4million has been spent.

NHS England has argued that it plans to commit the remaining funds by the end of this year.

However, GP leaders, who have already criticised the lack of immediacy in NHS England’s actions on other support packages, said there was still “much more to be done” to support practices in need.

A spokesman for the General Practitioners’ Committee (GPC) said the remaining cash needs to be distributed so it can provide vital support to practices in need.

Meanwhile, a spokesman for NHS England has admitted that the organisation has not done enough to get financial support “out the door” to practices in trouble.

The fund was intended to be used to parachute in teams of managers and legal support to help vulnerable practices adopt new ways of working or collaborate at scale.
However, it has been revealed that, in some areas the practices in the most precarious position had not been able to unpick the red tape in place to access funds. This had initially included practices having to match the funding offered to them but this requirement has been scrapped.

NHS England has subsequently launched a £42million Practice Resilience programme, which aims to invest £16million in 2016/17 as part of the GP Forward View.

The Carr-Hill formula, which is currently used to determine the basic global sum received by practices based on the demographics of their patients, is under review, and there are concerns that these atypical practices do not receive sufficient funding to support them.

A spokesman for the General Practitioners’ Committee (GPC), which has been in talks with NHS England over the matter, said that the contract, which could be national or local, could be one option to solve problems exposed by the withdrawal of the minimum practice income guarantee (MPIG) and Personal Medical Services (PMS) premiums.

He added that it is “simply not possible” to have a single national contract that can do justice to the specific needs of practices that have certain atypical populations and said that in some cases it may be possible to look at a contract designed for the needs of certain categories of practices, while in others, the atypical nature may be very specific to the practice, so would need a particular arrangement.

The atypical populations that have been suggested include practices with young populations, those caring for the homeless, drug users and nursing home patients and those with large numbers of temporary residents.

However, the new contracts may not apply to all of these groups and NHS England will report to the Carr-Hill Formula review steering group regarding which populations could be included in the review and which would require an alternative solution.

Commenting on the proposal, a spokesperson for NHS England said that it will continue to work with the GPC on the review with the aim of adapting the formula to better reflect workload and deprivation.

Future Fifty supports the UK’s top 50 growth-stage tech firms through a combination of development workshops, access to government contacts and services, promotional opportunities and collaboration.

In a statement published last week, the organisation said that businesses wishing to qualify for the programme must be UK-based, have an annual revenue exceeding £5m and be growing at 30 per cent year-on-year.

Meanwhile, the six-month Upscale UK programme is focused on early-stage start-ups helping 30 promising businesses to scale up by providing expert mentoring, networking and promotional opportunities.

Potential applicants for this programme must be headquartered in the UK, have achieved 30 per cent month-on-month growth for the last six months and have completed a Series A or equivalent. Bootstrapped firms must have £500,000 in revenues.

As a spokesman for Tech City pointed out, Future Fifty and Upscale UK are designed to support the different needs of high growth businesses and scale-ups, surrounding each team with their peers and industry experts who really understand the challenges they face as they expand.

He added that Tech City is delighted that its Future Fifty companies are now becoming scale coaches as well as role models for aspiring entrepreneurs, playing their part to create a sustainable ecosystem.

The deadline to apply for both the Future Fifty and the Upscale UK’s programmes is a minute before midnight on 7 December 2016.

Speaking at the recent Best Practice conference in Birmingham, Mr Hunt said he thought it was “quite sobering” to note that the entire outpatient budget for hospitals is around the same as the entire general practice budget.

He added that he believes patients would prefer to have their medical problems solved inside general practice rather than being referred to hospital. Therefore the Department of Health (DH) is going through the system “condition by condition” and asking what barriers can be removed centrally to allow more of the work to happen in general practice.

Acknowledging that this would involve more work for GPs, the Health Secretary said that this would be paid for and argued that it would make “life more rewarding” for doctors and would allow patients to be seen more quickly. However, he also admitted that the DH was looking at how it would fund the shift in workload.

The announcement was made at the same time as NHS England has said it is in the process of developing a new voluntary GP contract for large-scale multi-disciplinary GP practices with 30,000 or more patients, which will aim for them to employ a wider range of healthcare staff.

It also came as the General Practitioners’ Committee (GPC) announced it has been successful in convincing NHS leaders to amend hospital contracts to stop ‘workload dump’ from secondary care colleagues at a time when GP practices are facing “unprecedented pressure”.

Across the whole of the UK, Health Education England (HEE) has missed its mandated target by 10 per cent, having recruited 2,936 trainees for 3,250 positions. However, uptake has improved by almost 80 per cent in areas such as Yorkshire and the Humber and many programmes in the South of England are oversubscribed.

The biggest gaps are in Scotland, where 138 of 425 places are left unfilled; an under-subscription of 32 per cent. Despite how this looks, this is still a considerable improvement on 2015.

Meanwhile, the subscription rate in Northern Ireland is 99 per cent, while Wales, which launched a marketing programme including 320,000 bursaries to promote training earlier this month, is at 96 per cent.

As a spokesman for the HEE pointed out, even though it has been a difficult year for doctors in training, the overall fill rate across all medical specialities has remained fairly constant.

However, a representative of the General Medical Practitioners’ (GPC) education, training and workforce subcommittee said that the current figures still leave general practice in England hundreds of GPs short of the Government’s target. He therefore called on ministers to implement recent promises in the GP Forward View so that sufficient GPs can be recruited and retained.

Meanwhile, a spokesman for the Royal College of General Practitioners (RCGP) in Scotland said that the recent announcement by the First Minister to move 11 per cent of NHS spending to general practice should help to turn the situation around.

According to private advice firm Babylon, which paid to advertise their services to attendees at the conference, GPs could earn between £50 and £60 per hour by offering consultation to patients by mobile, increasing their earnings by £90,000 if they work full-time equivalent hours.

However, a spokesman for Babylon said that the extra work would only be likely to be undertaken by GPs who are juggling family and professional commitments, and value the flexibility of the timing. He added that, without this flexibility, many would not work additional sessions to their NHS work.

Meanwhile, separate research has found that the Health Secretary’s promise to increase the number of GPs by 5,000 by 2020 will actually deliver less than half the number needed to fill the workforce deficit.

According to a study conducted by Imperial College, even the ‘most optimistic’ scenario would require an extra 12,000 GPs to fill the gap, which is even higher than the 10,000 predicted by the RGCP.

According to the Department of Health (DH), the recruitment of 10,000 new primary care staff by 2020, including 5,000 new doctors in General Practice, is an ambitious target, which is based on an independent review of primary care services.

A spokesperson added that the DH is working towards this ambition with NHS England and Health Education England to help deliver a safer NHS for patients seven days a week. He also said that the Government is “boosting GP funding by £2.4 billion a year by 2020/21 and taking measures to retain and return GPs to the workforce.”

This is a rise of more than £1,000 to the £2,300 offered on the existing scheme, which helps doctors who are returning from a career break or time abroad, and there will be additional funding to cover indemnity and professional registration costs. The scheme will also support GPs with the completion of paperwork, occupational health assessments and co-ordinating their placements.

The funding includes a £1,250 bursary, available until 31 October 2018 to help with indemnity costs. It also offers £464 towards membership of the General Medical Council (GMC). In addition, there will be new funding so that assessments can be run bi-monthly instead of quarterly.

According to NHS England, the new scheme will be more flexible and has new requirements, such as that ‘suitably trained and experienced GPs’ will not need to go through its processes.

This is an improvement, as after the scheme began in 2015, many GPs were put off by needing further assessments. In fact, only one out of the 108 who completed the initial assessment then returned to practice.

NHS England has said that over the next few months, they will develop a new framework ‘so that suitably qualified and experienced doctors can be added to the Medical Performers List without the need to complete the I&R process.’

As a spokesman for the British Medical Association (BMA) pointed out, one of the key factors undermining general practice in the past few years has been the mounting workforce crisis that has left many GP practices without enough GPs to deliver an effective service to patients.

An important issue has been the ongoing and unavoidable barriers that are put in place of GPs returning to work after taking career breaks or leaving the NHS for short periods. The BMA has therefore worked with the Government to design fresh induction and retention schemes that are properly funded.

The problem concerns an error in the Total Reward Statement (TRS) online portal and is affecting GPs who had had ‘officer status’ before 2000, which are those who had contributed to the pension scheme while working in a non-medical role.

According to a NHS Pensions spokesperson, the organisation identified that 8,500 statements for this cohort were potentially incorrect and access by these members was removed by the end of August.

The spokesperson added that if these members were able to access their statements before they were withdrawn then any pension benefit figures would have been understated.

NHS Pensions said that it plans to provide correct updated information via TRS in late November or early December but said it cannot easily distinguish between different practitioner types on its system, although admitted that the majority were GPs.

As commentators have pointed out, this state of affairs means that affected GPs are unable to plan their finances and doctors have said they are ‘in the dark’ about their final pension. One said that it is a highly specialised area and very complicated. They need to allow professionals to help them but the information for the future is not there. The TRS portal is really helpful to someone who is going to retire now, but the delays mean that GPs will not know what their pension is, which is totally unacceptable.

One doctor reported that he tried to access his final statement as his retirement date is just weeks away but discovered that his records were missing from the portal. He said it meant he was not going to be able to get information about his pension, which is “incredibly frustrating”.

One of the main reasons for the lack of GPs is that rising numbers of family doctors are retiring early, possibly due to Treasury rules that have increased tax rates for those with pension pots worth more than £1m.

Meanwhile, the number of trainee doctors choosing to become GPs is falling far short of demand and, shockingly, in Yorkshire, the NHS Doncaster clinical commissioning group admitted that its out-of-hours services had been operating without a single GP to treat patients who fell sick overnight.

A number of areas are trying to ramp up recruitment, with health service managers in Cumbria, for example, drawing up plans to recruit refugee doctors to work locally as GPs.

In this area, which is one of the several offering trainee GPs “golden hellos” of £20,000 on top of their salaries, the proposals to employ foreign doctors who have been granted asylum follow NHS research warnings that general practice in the area is “very fragile”.

As one of the members of Cumbria’s Clinical Commissioning Group (CCG) pointed out, while employing competent, English-speaking doctors is valid, the longer-term solution would be for the NHS to understand what attracts people and redesign the job accordingly.

However, according to the NHS, the various recruitment proposals are not formal and are part of schemes that will go to public consultation. Meanwhile, a spokesperson for the Department of Health (DH) said that total investment in general practice in England rose to over £9bn in the last year; an increase of almost 5 per cent from 2014/15.