Written evidence submitted by Dr Charlie Besley (FGP0065)

By way of introduction…

… I am a General Practitioner, having completed my training in 1996 and a partner in a practice since 1998 – with a break between 2006-2011 working overseas in East Africa.

… I am sadly about to finish in General Practice, but not leaving NHS service; taking up a position in Palliative Medicine instead.

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

I think barriers for patients are simply a function of excess demand. Society has changed in recent times to an Amazon Prime’ expectations, such that if I can’t get what I want delivered tomorrow then it’s not good enough! In my practice 2 years ago it was not unusual for patients to wait > 2 weeks for an appt. Now you have more ways to access – phone, letter, email, e-Consult, SMS – will usually get a reply within hours, or at least 2-3 days, and yet society (& particularly the media) tell us we, in Primary Care, need to do more…?

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

This has been received very badly by the Primary Care work-force & contributed to further demoralisation of an already exhausted band of public servants… this will not help patients at all & merely contribute to a further loss of work-force…

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

The inverse-care law will continue to be true!

-          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?

We have worked hard in our practice in recent years to promote continuity with patients encouraged to stick to a ‘usual GP’… however they have also benefitted from expansion & diversification in our multi-disciplinary team – this has been well-received generally. GPs functioning as ‘specialist generalists’ or ‘family medicine consultants’ managing a Primary Care Team is a good model…

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

Survival I think… My impression right now is that General Practice is at significant risk of completely collapsing, and without it (& it’s ‘gate-keeping’ role), Secondary Care will quickly follow. I could mention public demand, lack of workforce, aging population, advancing complexity… but all these pressures are well documented… For me biggest ‘system’ challenge is to keep the connection between those ‘on the ground’ and those in the positions of power / decision-making… I am not convinced the new ‘Integrated Care System’ approach will do this, as it moves away from ‘Clinical Commissioning Groups’ which were at least ‘member organisations’…


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

Hugely… & that’s the strength of the partnership model of General Practice / Primary Care provision, as we can bend & flex our services to adequately meet the needs of our population.

What part should general practice play in the prevention agenda?

Opportunistic, but not the primary driver as this needs larger scale Public Health involvement…

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

More good news stories and stop the media from continually bashing General Practice! Politicians / decision-makers need to demonstrate some understanding of what it’s like ‘on the ground’.

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?

I think Nigel Watson’s review of the partnership model clearly demonstrates the benefits, so I won’t re-iterate this… on a personal level I think the partnership model enables local public servants to react / bend / flex to the needs of their local population… although I can see the benefits of local collaboration with neighbouring partnerships within a geographical locality.

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

Not really… not yet anyway… there are moves in this direction with Primary Care Networks, but it is still so ‘low-trust’/ ‘highly regulated’ in approach from NHSE that it wastes so much administrative time. I realise that accountability re: public purse spending is important, but at the peak of CoViD-19 when we were asked to adapt / change / launch vaccination sites, etc. ‘rules’ seemed to relax a little & we were trusted ‘to get on with it’… We did so, forming better relationships between partners in local practices, community services & other providers… Now someone has the ‘red-tape’ out again & it’s so disappointing!

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

There are lots of good things which have come from PCN development, and improved relationships with local health & care stakeholders is the main thing, as well as expanding the MDT approach to Primary Care… our local CCG have been excellent in helping to navigate the ‘red-tape’, but I fear it will not reach its full potential if micro-management continues…!

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?

Good question… it doesn’t feel like any of the recent changes have ‘freed up more GP time for patient care…’ I am now working longer hours than ever before, and > 50% of my time is spent with non-direct patient facing activities… this is not sustainable & has contributed to why I’m leaving.

Health & Care workforce is exhausted… the NHS is cracking, literally before our eyes; policy-makers need to be extremely careful otherwise we risk losing one of the exemplary health care services in the world!

Dec 2021