Written evidence submitted by Warwickshire Local Medical Committee & Coventry Local Medical Committee (FGP0066)

 

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

Quite simply supply is less than demand.  There is

i.         Insufficient GP numbers. Although the government has started to address this issue, the reality is that these individuals will not be working as GPs for a good number of years.  Even then it takes time to build up the skills and knowledge to manage the huge risks GPs face daily.

ii.       Insufficient other practice staff.  Although the PCN have recruited additional staff who can increase supply these staff and their roles are new and they are requiring hours of training so it will be some time before they are fully operational.  Training and supervision of these staff sits with the GPs and is taking time away from delivering frontline care. Once they are fully operational, they take more time with patients, order more investigations and are more risk averse so may not overall be cheaper than GPs. 

iii.     Increased demand.  This was an issue prior to Covid but the below three are new sources of work that have occurred in the last 6-9 months.

    1. There are very few health announcements that do not increase GP practice workload. The vaccine roll-out has been a mini example highlighting this issue.  Every time the BBC announced changes (usually at least 24 hours before general practice was advised of the changes) the number of patients contacting practices increased.  The tone of announcements was such that patients were led to believe systems were ready and prepared for the unexpected changes. For example, the recent announcement that 40-49 year olds would be entitled to a booster didn’t note that this would not occur until November 22nd, This raised patient expectations and caused inevitable confrontation when patients were advised this system was not yet in place.  The vaccine passport for individuals vaccinated overseas has been promised since August but is still not in place and 119 sends patients to their GP.
    2. The increased telephone appointment systems used by Trusts means that the individual consulting is either unable or unprepared to issue blood forms and prescriptions and this workload is sent back to practices.
    3. Sajid Javid announcing patients can demand a face to face appointment.  Although this went down well with Daily Mail readers, it meant all those years of appropriate clinical triage and teaching the public self-management was undermined.  This feeds into an NHS that is being driven to meet want rather than need.  If this is how we want our health service to operate than referral criteria etc need to be removed or else patients are told they can have want they want (regardless of clinical appropriateness) but then GPs re having to advise them they cannot  be referred which causes frustration and leads to GPs being seen as blocking the patient receiving the care they ‘want’.

1.       The plan offers hope for the future but does nothing to address current concerns and the punitive tone of it has led to at least 2 early retirements locally,

2.       The additional clinical staff were hugely demoralised by Sajid Javid’s announcement as the way appointments were counted in the plans didn’t include appointments with any Health Care Professionals other than GPs. This effectively started that their contribution was not considered valuable and was neither needed nor wanted. The PCN DES has driven the use of additional roles but this Plan doesn’t include them in any calculations related to access.

3.       The four proposals to reduce practice admin are welcomed.  Paragraph 28 could make a significant impact on un-necessary bureaucracy and also improve the patient journey.  Some of these changes have been included in previous NHS contracts to Trusts but there does not appear to be appropriate mechanisms in place, nor proposed, to ensure these changes become embedded in NHS systems. Robust monitoring of the implementation of these proposals needs to be assured.

4.       It is disappointing that there is no recognition of the issues, or a management plan, to reduce inappropriate workload arising from ill-timed or ill-judged press announcements.

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

1.       Anger and frustration are very visible impacts -fueled by expectations unrealistically raised – which reduces morale and in turn reduces supply.

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

 

 

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

Increasing demand from

 

Reduced supply arising from

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

What part should general practice play in the prevention agenda?

 

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

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

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

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?

Dec 2021