Written evidence submitted by Paddington Green Heath Centre (FGP0013)

 

I submit evidence as Senior Partner at Paddington Green Health Centre, an inner city teaching Practice serving 10,000 patients in an area of high deprivation with wide ethnic diversity.

Re Barriers to accessing GP and how can they be tackled:

Essential:

Functional phone systems which can be operated easily by all – preferably without long waiting times to answer – that’s down to number of admin staff able to answer at busiest times and number of phone lines in to the surgery.

Training in signposting eg to pharmacist team / nurse practitioner/social prescriber / district nurses: that’s down to manpower resource again as GP’s cannot possibly deal with all queries

Having a smart phone – if there is ability to interact through e-consult / text / sms/email then efficient work can be done at the patient and clinician’s convenience. This is achieved through links where information can be sent to patients regarding diagnoses or treatment and questions can be filled by patients which are then uploaded to the personalised records

e.g re management of chronic illness. It is also helpful for doctors to see photos / video clips using this widely available technology.

Triage systems In house and at Hub level so that the signposting can go on without a second triage at practice level unless suitable for an individual patient or concern

Learning between clinicians and admin on the ground in real time triage every morning when calls are busiest.

Impacts when patients can’t access using their preferred method

may use private on line platforms to get immediate help – suitable for acute / self limiting illness and advice

may be asked to phone again on a different day when their preferred clinician is in. This just kicks the can down the road hence working in teams option below

 

Having a named GP

Need to get to know more than one doctor so that care doesn’t fall down when one is off and continuity of care is contained, efficient and safe for a patient at all times.

Working in teams can help with this and so patients are effectively in a named team (not aligned to one registered doctor ) eg 3 doctors  ; 1 partner + 3 salaried ,1 nurse , 2 admin per 3000 patients  scaled up according to practice size.

 

Reducing Bureaucracy / burnout / improving morale

Basic courteous level of respect by those in the press and government would go far not to demoralise a hard working profession – which of course you may well need in later life even if you don’t now.

Scale up pay to allied professionals : District nurses , practice nurses , pharmacists , nurse practitioners, paramedics to make it attractive to work in the community .

Main challenges in the next 5 years

A change of government that wants to do yet another redesign in order to put its own stamp on. Whilst we’re battle hardened with change we’re a bit fed up of it too.

Early retirement of those who have years and years of valid experience to offer -working part time is the way forward here and that definitely does not mean part engaged with most people , just sustainable .

Is current partnership model sustainable?

We need both partners and salaried to work well together, I can give many years of example of list management by salaried GPs working together or with partners . Let’s not get too hung up on how doctors are paid but concentrate on what they can offer as clinicians which is useful to patients. I imagine it’s of very little interest for a patient to know that I am paid by gross profit share and the doctor they speak to next time is paid net in a salary as long as they are looked after well.

Most salaried doctors are hard working clinicians who just don’t want to get involved in the daily business of running a practice, most partners are interested in various aspects of that

eg personnel, finances , teaching / training , wider scale operations

Both are essential for small business operations and known to be more effective in providing local based personalised patient care than if taken over by a corporate .

 

Should GPs play a part in the Prevention agenda ?

This is not a new part of our work – we do this all the time and well before the Pandemic .

Note smears test to prevent cervical cancer , childhood immunisations , stop smoking clinics , referrals to gym / weight loss / social prescribers  , flu clinics , PCN led vaccinations sites  ….

However the part of Public health was never made more clear than with the Covid pandemic –through necessary daily media flanked by the PM behind lecturns .

I think that was successful in driving messages home and so more media with known household names and GP’s could be the way forward .

 

Nov 2021