Written evidence submitted by Dr Jeremy Dobbs (FGP0044)

 

A personal view from an experienced rural GP in Dorset.

I have been a GP in a small rural practice (4000 patients) for 26 years.

Whilst originally a very stressed and overworked full time GP (working 70 hours per week) I have been fortunate over time to be able to shape my work to be a very enjoyable and satisfying ‘part-time’ career working about 40 hours/week over 3-4 days.

 

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

Sheer volume of work seems to be the main barrier for many practices. This leads to inefficient and inappropriate use of barriers such as eConsult and 111 which have replaced direct verbal communication with many practices’ knowledgeable receptionists.   (Though verbal abuse of these staff is a common problem too.)

I also feel that the loss of continuity of care for many patients creates duplication of work and loss of trust.

We are fortunate to have avoided all of this by having long term Partners who know their patients well and a very experienced Integrated Nursing Team (INT). The INT spans across from the practice treatment rooms into people’s homes as ‘district nurses’ maintaining continuity of care from cradle to grave.

The employment of an in-house First Contact Physiotherapist and Social Prescriber have been excellent initiatives by the Locality reducing demand on the GPs whilst maintaining excellent teamwork within the practice.

Whilst we strongly advocate the principle of continuity of care of ‘Named GPs’ this occurs by default by us encouraging continuity when patients ring reception and in our teamwork. It is the availability of those GPs that is crucial otherwise it is simply a ‘Name’ without access!

 

What are the main challenges facing general practice in the next 5 years?

The loss of MANY experienced retiring GPs. I fear this will need to many more mergers of practices and the employment of Salaried GPs rather than Partners who INVEST in their practices and enable them to thrive and remain resilient. I fear the loss of traditional ‘local’ practices that are owned and run by Partners for their local community. Generic General Practice does not serve communities.

 

How does regional variation shape the challenges facing general practice in different parts of England, including rural areas?

From a rural point of view we see a lack of locums and young prospective GPs living and working in our rural area. They SEEM happier in the cities? Are we training fewer medical students from the Rural areas? Are medical students not experiencing rural general practice?

 

What part should general practice play in the prevention agenda?

Whilst QoF supports prevention it is right that Smoking prevention & Health Checks have been handed to Pharmacies!

 

What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?

QoF can be simplified much further, and the use of technology expanded eg Florey, to focus the attention of General Practice on those most in need, rather than the well-controlled chronic disease and the ‘worried well’.

 

Is the traditional partnership model in general practice sustainable given recruitment challenges, the prioritisation of integrated care and the shift towards salaried GP posts?

The loss of the Partnership model would lead to the loss of many SMALLER practices with the huge loss of connection with communities, local knowledge and continuity of care. We survive as a small practice BECAUSE of the Partnership model. Without it General Practice will become generic and without a soul. Our staff come from our community and feel part of it alongside our patients. There is loyalty and mutual respect which sustains us all.

 

 

Do the current contracting and payment systems in general practice encourage proactive, personalised, coordinated and integrated care?

I think it is ETHOS of the Partners and the practice that drives this rather than funding models.

 

Has the development of Primary Care Networks improved the delivery of proactive, personalised, coordinated and integrated care and reduced the administrative burden on GPs?

It has relieved some strain on GPs and helped patients access us. So yes, more personalised.

Administrative burden seems greater for our Managers!!

 

To what extent has general practice been able to work in effective partnerships with other professions within primary care and beyond to free more GP time for patient care?

It HAS enabled more joined up working with our Hub and Rehab Team and enabled more in house professionals eg FCPs and Social Prescribers.

Dec 2021