Written evidence submitted by Dr Alex Rose. Clinical Director for Winchester City Primary Care Network and Partner at St Paul’s Surgery Winchester (FGP0027)

What are the main barriers to accessing general practice and how can these be tackled?

The sheer volume of contacts from patients means they can be fighting to have their voice heard. Contacts have increased 30-40% compared to pre-covid levels despite several other services trying to take work away from General Practice (first contact MSK, minor eye conditions service, for example)

The level of anxiety in the general population is extremely high and trying to differentiate between pathology and psychosomatic factors can be very difficult. Mental health has deteriorated significantly and the services available for these patients are inadequate.

The narrative from the Government is that you are entitled to see your GP face to face and this goes against what was directed at the beginning of the pandemic. What is clear is that GPs are unable to manage the level of demand with the previous model and a mixed model is currently the only way of coping. The Government’s narrative has been directly driving demand from patients and further hindering the recovery in General Practice.

The recent Winter Access Fund is an example of the Government being completely out of touch with the realities facing General Practice and offers no real solution to the issue.

These plans contribute to the problem as they require a great deal of communication and discussion, further taking away GP access. We end up debating how we can use this fund in an impossible situation which is time consuming for something which is only going to last a few months.

The strict target based approach to PCNs also hinders innovation and improvement in patient care and access as ARRS roles are focusing on these rather than any tangible benefit or workload reduction.

Increased contacts to hospital, OOH and ED.

We run a strict list based system in St Pauls and it works really well. We can have up to 50 contacts a day from patients but in the context of knowing them and the family, decisions are much easier and quicker. This is the only way of managing the high level of demand

Early retirement and reduction in GP numbers. Reduced sessions. Increased management and supervision of other roles under ARRS. Contraction of other services as PCNs enlarge which will result in no new capacity and GPs now running a service they didn’t do before.



General practice struggles to firefight at the moment. It isn’t going to have the capacity to be involved in a prevention agenda. This needs to be incorporated elsewhere.

We need a supportive government who are listening to the challenges facing us. We need realistic expectations set by them to our patients. Greater focus on self care. Reduced top down target based approach.


The partnership model is working well in our practice in Winchester. We are rare in that we have almost all doctors as partners. We do, however, have good access to recruitment as we are in an affluent area where a number of doctors live. I imagine this isn’t the case elsewhere. I think we deliver a high quality of care as we are involved in all the decisions and processes.

No, they are target based and the same throughout the country

No, it has considerable increased the administrative burden on GPs. I have reduced my clinical sessions in order to facilitate PCNs, reducing my patient access. There have been some benefits to the ARRS roles but they require supervision and training and this seems to be a net input at the moment. The roles are then not delivering personalised care as they are working towards the proscriptive NHSE targets.

First Contact physiotherapy has been a good example of workload being taken away.

Minor eye condition service and seeing optician first has also been helpful


Nov 2021