Written evidence submitted by Bourne Galletly Medical Practice (FGP0050)

 

 

The future of General Practice

 

General practice is and has been the foundation stone of the NHS since its inception in 1948.  General practices deliver patient centred holistic care, continuity of care, health promotion, and disease prevention through multi-disciplinary teams close to patients’ homes. General Practice has and continues to work hard to provide a one stop care facility in aptients geographical communities at a fraction of the cost experienced in larger acute settings.

General practice, along with the entire NHS, is experiencing unprecedented pressure which has been exacerbated by the Covid-19 pandemic.  General practices have, despite this, continued to provide excellent care to the population.  

This paper sets out a summary of what general practice is currently doing, what the challenges are that face general practice, some potential solutions, and reasons why these solutions should be implemented.

The good work being done now in our Practice

 

Challenge

Action for DHSC and NHSE to reduce the challenge

Workload- 23% increase in appointment demand in 3 years.  More complexity as population is older and higher disease prevalence2.

Cease the use of General Practice as dumping ground for unfunded or non-commissioned work. Ensure NHSE/Regions and CCGs truly place General Practice at the forefront or Pt Care and support the innovations within

Workload- Public expectation, fuelled by politicians and press, is that general practice should be immediately accessible, which leads to unmanageable demand.

Reduce public expectation of immediate access by changing the rhetoric and encouraging self-care

Workload- Bureaucracy from transfer of work from secondary care is placing an ever-greater burden on practices [3][4][5]

Provide strong contractual levers to prevent inappropriate transfer of work from secondary to primary care, or develop systems whereby this work can be done in primary care and is adequately resourced

 

Workload- Multiple commissioners and contracts causes practices to have to spend time and resources on making claims

 

Simplify GP contracts so that the funding flows through fewer contract streams

Workload – multiple payment streams none of which work.  Constant incorrect, late or missing payments.

remove PCSE who are not fit for service and creating huge financial issues with incorrect pension/contract and Partnership payments

Workload- Multiple regulators inspecting practices diverts clinicians and administrators from patient care

Have one regulator, trust this regulator to do its job, and stop scrutiny of practices by other organisations

 

Workforce- Fully qualified GP numbers have fallen to 0.45 per 1000 patients from 0.52 in 2015.  There are 1700 fewer full-time equivalent GPs now than there were in 2015[6]

  • Increase space at medical schools to train future doctors so more can become GPs
  • Increase investment in general practice training
  • Increase the exposure of trainees in all medical specialties to general practice
  • Stop the denigration of general practice by politicians which undermines the profession and reduces the likelihood of doctors joining the profession, and increases people leaving the profession

 

Workforce- Alternative Roles have not filled this gap with ARRS funding underspent in many CCGs[7][8].  This worsens inequalities as recruitment is more difficult in PCNs with deprived populations

 

Allow ARRS funding to be used for other things when practices and PCNs are unable to recruit

Morale- 37% of GPs have expressed an intention to leave general practice in the next five years, and this proportion increases to 63% for GPs aged over 50. 55% of GPs have indicated that they want to reduce their working hours in the next five years, and this proportion increases to 73% in GPs aged over 50[9]

Proactively acknowledge the good work done by general practice and rebut negative press about the profession

Morale- On average GP works 40 hours per week, but this is over 3.125 days, so the average working day for a GP is 12.8 hours.  However, there is a perception that GPs work “part time”[10], which impacts morale

Proactively rebut the assertion that GPs work “part time”

Funding- BMA has called for general practice to receive 11% of the NHS budget.  The funding is currently approximately 9%

 

Increase the funding for general practice so that it receives 11% of the NHS budget

Funding- The formula which distributes funding to general practices disadvantages patients in deprived and rural areas, which worsens health

Review the Carr-Hill formula to address the inequalities it causes

Funding- The risks associated with premises ownership is a barrier to GPs committing to an NHS

Review the premises model for general practice to reduce the risk for individuals

Contract holding (partnership)- 55% of GPs now choose to not hold an NHS contract and are employed by practices or are locums.  Contract holders are responsible for delivering services and the risks associated with this.  Having fewer contract holders increases the individual risk and is cited as a reason for contract holders wanting to leave the profession.  The independent contractor (partnership) model has consistently delivered high-quality cost-effective care for patients.  The diminishing number of contractors correlates with decreasing patient satisfaction[11] possibly due to reduced continuity of care

Simplify and refresh the GP contract to make it more attractive for GPs to be contract holders.  Allow partnerships to work to its strengths:

  • a freedom to innovate
  • relative autonomy in decisions relating to patient care, with the ability to act as a powerful independent advocate for patients
  • being part of, and accountable to, a community
  • creating the desire to succeed as business owners
  • providing value for money[12]

 

Why should government follow this advice?

 


[1] https://doi.org/10.1136/bmj.j84

[2] https://digital.nhs.uk/data-and-information/publications/statistical/quality-and-outcomes-framework-achievement-prevalence-and-exceptions-data/2019-20

[3] https://www.humbersidelmc.org.uk/lmcpublishesreportonprimarysecondaryinterface

[4] https://www.lincslmc.co.uk/contractcomplianceweekupdate

[5] https://cambslmc.org/wp-content/uploads/2020/11/Covid-19-GP-Capacity-Report-Beds-Cambs-Herts-LMCs-Nov-2020.pdf

[6] https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services

[7] https://www.gponline.com/millions-pounds-lost-general-practice-flagship-recruitment-scheme-falls-short/article/1727866

[8] https://doclibrary-kccg.cornwall.nhs.uk/DocumentsLibrary/KernowCCG/OurOrganisation/PrimaryCareCommittee/202122/202106/PCCC2021107AdditionalRolesReimbursementSchemeForPCN.pdf

[9] https://prucomm.ac.uk/assets/uploads/Tenth_GPWLS_2019_Final_version_post-review_corrected_1.pdf

[10] https://www.dailymail.co.uk/health/article-7982773/Just-one-10-GPs-working-time-40-switching-locum-work-earns-200-000.html

[11] https://www.gp-patient.co.uk/about

[12] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/770916/gp-partnership-review-final-report.pdf

[13] https://www.england.nhs.uk/2019/07/nine-out-of-10-patients-have-confidence-and-trust-in-their-gp/

[14] https://www.ipsos.com/ipsos-mori/en-uk/ipsos-mori-veracity-index-2020-trust-in-professions

 

 

 

Dec 2021