Written evidence submitted by Dr Sam Robinson (FGP0047)

I am a full-time GP partner working in general practice and have worked in Bath at Combe Down Surgery for the past 19 years. I am also the Clinical Director of our local PCN “Minerva”. I want my considerations to be submitted as I am passionate to support General Practice and make is a more productive, pleasant and sustainable profession to work in in the future. As a GP trainer I am concerned about the relentless workload and how this will alienate newly qualified GPs and damage the profession and quality of patient care unless something changes in the near future.

Working conditions and expectations need to improve in order to attract the GPs of tomorrow.

If we manage to sort out General Practice and help shape the working day into something that is structured, rewarding and valuable and give enough time for clinicians and patients to engage in a meaningful way. As well as ensuring there is long-term support and confidence in the partnership model to encourage younger GPs to buy in and become the partners of the future; then we will have no trouble recruiting enough GPs for the future. (as long as we start training enough!!)

The current demands on General Practice are unsustainable and I am frustrated at the fact that GPs seem to be taken for granted and that the NHS constantly tries to push work from other parts of the system into primary care and the system doesn’t seem to be able to protect either GPs or A&E from the relentless increasing demand of patients in a system with limited resources.

The main issue with access is a lack of GPs and despite years of this crisis building it is too little too late now to try and remedy this. The adoption of allied healthcare professionals in the PCN ARRS scheme has started to help us compensate for this, but sadly this may lead to the loss of the true generalist and patient continuity of care. If we make primary care a secure, well respected and attractive workplace and things will take care of themselves. If we continue to flog it with unsustainable asks and insufficient resources then GPs will continue to reduce their hours, retire early or simply burnout.

The recent winter pressures paper to supposedly support general practice was unhelpful and simply missed the point angering the profession when they were already tired and struggling to manage. Trying to performance manage GPs and making more and more bureaucratic work and reorganisation within the NHS simply saps energy from those who are best placed to provide patient facing care.

Primary care needs to be truly valued by politicians and the public and much as people understand that there are only a certain number of hip operations that can be done each year, we need to have some sort of recognition that primary care cannot continue to work more and more as we are on the verge of practice becoming unsafe at times due to the excessive pressures being placed on the system presently. There is also a limit to how many GP appointments can safely be done within a working day, GPs need to be treated more like a finite resource to be nurtured, supported and developed and protected so that we can best use our skills for those patients who really need us.

If Primary Care starts to fail and patients cannot easily access their primary care team when necessary, the fallout will be immense. Patients will simply turn to A&E and this will in turn cripple secondary care. Primary care cannot be allowed to fail as it is the backbone of the NHS.

Continuity of care is key to most complex patients, although not so critical for on the day acute presentations. There is no doubt that knowledge of a patient and experience and trust can hugely reduce the strain on the rest of the healthcare system and reduce repeat attendance and unnecessary referrals and investigations. Unfortunately, as GPs continue to regularly work 12-13hr days they will continue to work less days or “part-time” as the press likes to quote to avoid doing a regular working week in excess of 60hrs. Unless workload changes this perception of part-time and less time available to see patients face-2-face will continue. Please let us accept that a 3 day week with 12 hour days, with an evening meeting for 2 hours afterwards and a Saturday shift for 4 hrs, not to mention working on the GP’s supposed day “Off” is actually more realistically like a 50 hrs week and not part-time at all.

There needs to be less top down monitoring and interference in order to let primary care thrive. The restrictions and limitations on the ARRS scheme have stifled innovation and delayed us being able to recruit the staff we really need.

In order to improve morale we need to government to celebrate Primary Care and value the hard work that goes on rather than looking at it as a scapegoat for system that is at breaking point due to years of increasing patient demand, practices being asked to take on more and more unpaid/ funded work from the rest of the system and a constant feeling of being undervalued by politicians.

I believe that the current partnership model is highly efficient and the NHS gets an awful lot of goodwill from GP partners who run well organised, locally responsive and highly valued (by patients) local surgeries with minimal core funding. As we move to an ICS we need a real levelling up so that primary care is paid the same for procedures as secondary care who often appear to have favourable tariffs and limits on workload that we can never dream of.

I actually think that QUOF is a positive driver for good patient care, but it unfortunately risks primary care being skewed towards the areas it covers and can then neglect those areas with there is no incentive or target. There needs to be a balance here and a recognition that those practices in more deprived areas have to work harder to achieve the same level of excellence.

PCNs have been a good thing to allow practices to develop a stronger local voice and identity, and start working more collaboratively with other organisations locally.

I can’t recall a time when we ever worked so closely with neighbouring practices and our relationships (having worked side by side doing vaccinations for COVID and supporting each other through the pandemic) are as strong as ever.

Despite being a Clinical Director of a PCN, I am not convinced that the advent of PCNs has reduced the administrative burden on GPs, yet. If anything, so far this has probably increased. I do remain hopeful though that over time this may change as we align processes and patient care pathways and start to share management and organisational structures to reduce duplication and to share good practice and play to each other’s strengths. I believe that PCNs will really start to blossom as we reach the end of the 5 year contract and should be supported and developed further at this stage instead of changing the whole organisational structure once more and setting us back to the start.

So far, as a result of the onerous supervision of the new ARRS staff and ongoing hefty training requirements we are not fully realising the potential of bringing in centrally funded staff into Primary Care. There are always going to be things that are better provided locally, and most patients would prefer to see their local GP and their local practice and to see a familiar and trusted face when they are ill or in need.

 

If Primary Care is to survive or even dare I say thrive in the future, then policy makers need to put their money where their mouth is and back General Practice. NOT force it to the brink of failure with unrealistic expectations. The response of General Practice to the pandemic has been awesome and the hard work goes on behind closed doors day in and day out.

Being a GP is still a complete privilege, but I truly believe that it’s future is in real danger unless there is a dramatic change in how it is valued and a levelling up to ensure the work done in primary care is valued alongside that done in secondary care which simply doesn’t carry the personal financial risk that GPs have to carry.

As PCNs develop we need secondary care, the voluntary sector and community services to fit around primary care and work together to provide locally responsive and coordinated hubs.

Less interference and more trust and fair resources please.

Lets try and help primary care recover and support GPs to do what they do best, care for patients and their local community.

 

Dec 2021