Written evidence submitted by Dr Corrin Phillips (FGP0064)

 

 

 

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

 

Demand exceeds supply.

 

Address demand –

Educate the population in appropriate self management of self limiting illnesses.

Educate the population in appropriate self management of their mental health and wellbeing.

Think about how pastoral and mental health support is given in communities and direct this away from general practice

Some kind of more dominant web based NHS Information algorithms may well help reduce demand – but the IT intelligence needs to evolve further for this to be safe - and the current algorithms – econsult and the like – currently increase demand.

 

Address supply –

Morale in GP is low. This impacts all areas of working.

Despite developing effective patterns of work in COVID in Triaging all patients and limiting footfall in surgery we have faced media campaign for patients to be allowed to book face to face appointments with no filter. What could be a 5-7 minute call and advice becomes 15 minutes of time with a patient with the same outcome.

Funding has been sluggish for 10 years and is insufficient to provide an adequate let alone good service.

Funding through PCN has been restrictive in how it is used and some PCN initiatives feel like “finding something, anything to spend it on”.

Less convoluted modes of accessing those funds currently channelled into PCNs would allow more flexible and efficient use of resources.

Although skill mixing has become the norm in GP, there is increasing experience that other practitioners (ANP / Paramedics / Physios / Clinical Pharmacists) generate as much work as they “save”. They have not got the skill to tolerate risk as effectively and efficiently as a trained GP does.

As a current GP trainer I observe that the current cohort of GP trainees is not attracting high quality doctors. This reflects the morale of GP in general. Making GP as a career more attractive needs to be addressed also.

Improving GP working conditions – which essentially means more GPs or less demand as above – would help attract new trainees.

 

 

• To what extent does the Government and NHS England’s plan for improving access for patients and supporting general practice address these barriers?

 

Imperceptible change. There has been a net loss in whole time equivalent GPs

 

• What are the impacts when patients are unable to access general practice using their preferred method?

 

The answer to this depends on who you talk to. Hospital and ED would say that lack of GP access leads to bigger pressures in ED. It is more complex than that. Most sensible adults tolerate a wait or access 111/ NHS on line. Patients whose access is limited get more angry in interactions with General Practice and further erode morale and make the retention of staff more difficult.

 

• What role does having a named GP—and being able to see that GP—play in providing patients with the continuity of care they need?

 

Given that working as a Doctor in General Practice is no longer feasible “full time” (daily working of 13 hour days is not physically or mentally possible for most GPs. We are highly trained in directing people to managing their health and lifestyle in a healthy way. We tend to take our own advice and strike a work life balance that inevitably means not being in practice every day of the week) moderate sized GP teams - up to 15 GPs - manage to communicate and cooperate together to give good quality joined up care and continuity for their patients – just by nature of practicing together. “Named GP” means very little in practice.

 

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

 

Recruitment and Retention.

 

Patient Demand: The “Information era” public who are being advised on line by international / USA Healthcare as much as the NHS. International English speaking Healthcare systems are driven by financial forces and encourage people to consult / book / take medication when this is not necessarily medically necessary, but is in the financial interests of the Private Healthcare industry. “Dr Google” is inherently risk averse (in the interests of protecting themselves from Legal comebacks) and tells people to see doctors with a very low threshold.

Some kind of more dominant NHS Information algorithms may well help reduce demand – but the IT intelligence needs to evolve further for this to be safe - and the current algorithms – econsult and the like – currently increase demand.

 

COVID – its not going away and the ongoing need for booster vaccines.

 

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

 

The mode of GP provision is effective in different ways for different populations – geographic and socioeconomic. There is not a “one size fits all” mode of providing Primary care.

 

• What part should general practice play in the prevention agenda?

 

There is no capacity within GP to do more than we are at the moment.

It would be ideal if we could work more on preventative medicine and lead people to learn more about how to conduct their lives in a way that maintains their health.

NHS Health checks are a positive thing.

 

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

 

A more constructive CQC process.

Less complex money flow – abandon PCNs and divert this money direct to Practices via GMS contract.

Continue COVID style appraisal.

Simplify QOF.

Fund GP properly so doctors want to become GPs and want to stay in GP jobs.

Reward good practice.

 

• How can the current model of general practice be improved to make it more sustainable in the long term? In particular:

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

 

This is tricky to answer. If the NHS has the funds to buy NHS properties from Partnerships and move to a new model of GP then this may be possible… I suspect there is not money to do this. Therefore the Partnership model with premises owned by GPs which still forms a large swathe of Primary Care has to worked with.

The Partnership model affords great efficiencies in making individual practitioners responsible for working effectively in order to maintain their income. More recently this has evolved in some areas to bigger practices with hierarchical layers of partners then salaried GPs.

Apparently there is variation in the quality of care that GP practices offer.

Beyond a certain size of practice continuity of care becomes fragmented and quality of care drops.

Somehow there needs to be a way of rewarding provision of efficient high quality General Practice. QOF did this to some degree.

The Partnership model relies on GPs investing financially. In the context of student loans and rising house prices, younger GPs often do not have the resources to invest financially in GP, and it feels increasingly risky to do so.

 

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

 

To some degree yes…

But there are limitations because of the problems with recruitment and retention – the funding is insufficient.

 

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

 

No.

The PCNs have generated another level of bureaucracy to access funds. The top down decision making about how the funds have to be used has generated inefficient dysfunctional teams.

 

• 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?

 

 

Challenging. There is a crisis in Community nursing locally. The Hospice Team rely on charitable funding which has dropped off in COVID. The community physiotherapy service is very rationed. The PCN has struggled to recruit good quality MSK practitioners. There is a fundamental conflict of interest with community pharmacists – because it is in their interests to sell people pharmaceutical products when they present with medical problems – which generates a transaction based consultation, and Pharmacists are trained in Pharmaceuticals so have a blinkered view on treatments – they are orientated to prescribing – not cost effective or good medicine. Mental Health Services are for “pure” psychiatry and crisis management it seem. Mental Health Charities are dependent on charitable funding and volunteers and are a limited resource. Podiatry has become a highly rationed service. Community OTs and SALT are valued and used appropriately.

 

Dec 2021