Written evidence submitted by Dr Kate McKenna (FGP0072)

Core contract is outdated and fundamentally floored. It assumes c.2.5 contacts per patient per year. Our Practice delivers c.4.3 contacts per patient per year. We have no way of knowing currently how this reflects actual demand due to outdated phone system. Payment is capped, demand isn’t.

Unrealistic patient demand. Needs to be education/information about what the NHS and General Practice is there for and what it can provide. Including timescales. Increase education regarding self care and self triage to support organisations

ARRS roles are good but triage still required (usually by GP to ensure safe practice) to ensure patients are seen by correct health care professional. Whilst salaries are covered in ARRS monies, the physical space requirements are not recognised meaning ironically, in our Practice, GPs are starting to have to work from home in order to create the required physical consulting space for ARRS practitioners.

Digital enablement is good in principle but eConsult has unleashed a monster. Patient demand is sky rocketing and an ‘Amazon Prime’ culture fuels (a 24/7) expectation and consequent patient dissatisfaction. I am also concerned that our most vulnerable patients are often the least digitally capable – this is therefore exacerbating inequality of care with a system designed to meet what the patient wants vs what the patient needs

They call 111, overburdening that system inappropriately. 111 re direct to the GP but inability to provide instant access then sometimes means patients will take themselves to the local Emergency department – again inappropriately

Essential if aiming to provide safe and effective care for our most vulnerable e.g those with chronic disease, those with safeguarding needs. Continuity probably also reduces the number of appointments required per patient so safer and more efficient. Acute/minor illnesses are arguably those that don’t need a named GP – although there is a case that says that ideally seeing minor illnesses means the GP has the potential to view the individual and their family ‘as a whole’ and spot issues

Decline in Partner numbers – we have had a 50% reduction in Partner numbers in our area in the last 5 years. Remaining Partners feel overwhelmed by the increase in risk (property ownership, lease liabilities and redundancy exposure) and are therefore at increased risk of handing Contracts back. This will provide a route in for privately back providers – I suspect their interest is not Primary care (because it doesn’t make a viable return) but they’re using Primary Care in order to gain a footing into the more lucrative Secondary Care sector. This isn’t in patients best interests and ultimately will cost the NHS more I imagine. The Partnership model is essential as it delivers ownership, commitment and a vessel through which to manage change and implement solutions e.g. delivery of vaccination programme at local level. Salaried GPs also essential obviously but will always have a more ‘job and finish’ approach (rightly so as fixed salary, fixed work).  

Decline in Doctor numbers (please stop demonising us and setting the public against us)

Underfunded social care exacerbates demand on Primary Care

Secondary Care waiting lists increases demand on Primary Care whose role it is to support patients whilst waiting for Secondary Care input

Patient demand and expectations – see previous

 

Not really able to answer other than to say if a PCN spans an area including a rural demographic then transport links limit the ability to be able to deliver services across the PCN population in a cost effective and accessible way

Way more than it’s currently able to. We are reactive and dealing with the consequences of unhealthy lifestyles and poor life choices. General Practice should be at the forefront of a prevention agenda

 

Renegotiate/restructure the Core contract. Currently too many bolt ons, additional contracts and commitments that make delivery unwieldy and overly bureaucratic

Recognise that what a patient sees as a successful outcome (for them) doesn’t necessarily align with the outcome metrics NHSE, CQC, QoF etc.. manage general practice by

Stop demonising GPs

Fund Primary Care in a way that reflects the value placed in GPs, in particular partners and the personal risk they carry around property and employment

Properly fund social care and align with Primary care

 Consider introducing LLPs as a way of mitigating a partners personal risk. Personal risk is a key barrier to salaried GPs taking up partnership

 

Do not under estimate the true value of partnership. A system based on salaried GPs results in fixed capacity which doesn’t align with uncapped demand. Partners carry huge personal risk, deliver the many and significant activities over and above ‘just seeing’ patients (as per a salaried GP) and they facilitate change, translating the demands pushed down from NHSE to local level. Recognise and value partners and there will be a shift in the current recruitment crisis. Consider LLPs as a way of mitigating a partners personal risk

 

No – too complex and unwieldy. Integrate health and social care payments and structure if you want truly integrated care

 

Yes and no. PCNs have an administrative burden all of their own and it’s GPs that are running and administering PCNs. So it’s just another role for GPs (as clinical directors) to have to fulfil and have their day job backfilled (if they can find the cover which unvariably we can’t in the current climate)

The ARRS roles are welcomed but come with their own management needs. The funding for ARRS roles only reflects pay and rations and doesn’t recognise the need to physically house them. GPs now having to work from home because no physical space in surgeries to accommodate new roles and CCGs slow to progress this issue

Any ‘free time’ has probably been mopped up by and ever increasing patient demand, delivering the covid vaccination programme and supporting neighbouring GP practices that have ‘fallen over’

Dec 2021